Working memory is more important to academic success than IQ, according to recent research.  Why is that important to ADHD parents and what the heck is working memory anyway?

Working memory is the ability to keep information in awareness until a task is accomplished. An example would be when you tell your child to do three things and only two get done ( if  you’re lucky). People with ADHD have very poor working memory, so your child’s difficulties in school are likely related to difficulties with working memory.

The research was recently published in The Journal of Experimental Child Psychology by Dr. Tracy Alloway. It indicates that working memory is more important to academic success than IQ. Working memory is also the best predictor of reading,spelling and math

IQ is a very unreliable predictor of academic performance. Indeed, if I only had a nickel for every time a parent has told me– “He’s  very smart , he just doesn’t get good grades.”

So, the bad news is that here’s another problem for ADHD kids.

The good news is that working memory is something we know how to improve. The research on neuroplasticity indicates that the brain adapts and adjusts to the demands we make on it.

Computerized Cognitive Retraining(CCR) is a very effective, well-researched and efficient approach to improving working memory. We have known that CCR improves working memory,but we haven’t had direct evidence that it impacts education directly. Now we do.

This research also explains why tutoring for ADHD kids is frequently not effective. It’s not aimed at the right target. Its not designed to, nor does it improve working memory.

CCR can specifically target working memory and improve it . The improvements take 20-30 sessions of CCR to become noticeable and they last because you’re training and structurally changing your brain. MRI studies show that CCR causes growth in the specific part of the brain targeted by the program.

The part of your brain that’s involved in working memory actually gets bigger and more dense. (Density is good in this case because it means more dendritic connections, that is your neurons are talking to each other better.)

If you have questions about CCR and ADHD and/or school performance, feel free to contact me.

ADHD kids are plagued by emotions that are frequently out of control. They are emotionally labile–happy one minute, enraged the next. They appear to have little control over their emotions.

This is a cause of significant distress for the child and everyone around him or her.

One of the characteristics of ADHD children who are sucessful in later life is the ability to deal with and manage emotions.

A useful set of techniques for dealing with emotion is cognitive behavioral therapy. The basic assumption of CBT is that our emotions are generated by the way we think about situations and events, not by the situations or events themselves.

This could obviously be a little abstract for a very young child, but it can be simplified by focusing on what the child is thinking rather than on what he’s feeling or shouldn’t be doing.

The discussion following an emotional outburst can then become a discussion of what you were thinking and how what you were thinking caused you to feel. Emphasis is always on you having responsibility for your emotions because you generate your emotions.

It takes time for the child to be able to use this technique. The major step is getting awareness of the link between thought and emotion  and acceptance of the responsibility for the emotion.

The second assumption of CBT is that if we change our thinking we change our emotions. Exaggerated emotions are caused by exaggerated (unrealistic or irrational) thinking.

Changing our thinking to more realistic and logical thoughts will result in more modulated emotions. It doesn’t mean you’ll never get irritated or frustrated  again, but it does mean that episodes of eyeball bulging, vein popping rage should be much less frequent.

Technique-after a meltdown,
1. help the child identify the emotion. Were you angry at Billy or afraid your friends would like him better than you?
2. help him identify the exaggerated thoughts–nobody will ever like me, I’ll be all alone forever. Billy’s a poop-head.
3.help him establish some emotional distance–through humor, exaggeration, distraction.
4.help him come up with more rational, logical thoughts–Billy’s not really a poop-head, I actually like him. I just didn’t like what he did today.Or even if my friends all played with Billy today, he won’t be here tomorrow and they’ve been my friends for years, so we’ll probably play again. And no, I won’t be alone forever.
This is a useful technique that improves with age and experience. It gives the ADHD child one set of tools for dealing with emotions. It’s also helpful for ADHD parents!

Disorganization is one of the hallmarks of the ADHD brain. We’ve already talked about the need for external structure to improve performance for ADHD’ers.

This is the first step in developing an internalized ability to organize. For a child with ADHD to learn to be a reasonably organized person, he or she must experience organization and observe organization. There must be an adult in the environment who is reasonably well-organized to serve as a model.

Knowing that the heritability of ADHD is about 80%, it is likely that there is also one disorganized adult in the environment. This adult must model attempts to be organized and, most importantly, place a positive value on being organized.

It’s really difficult for a child with ADHD to make efforts at being organized if one parent is extremely negative about organization or makes fun of it (look how obsessive-compulsive she is).

There is no one way to be organized. There are countless systems, organizers and strategies for keeping up. Some school systems even give out agendas. The problem is finding a match between the system and the ADHD’ers cognitive style.

There are two big differences in cognitive style which, in a gross oversimplification, we’ll call left brain and right brain.

The left brain organizational systems are typically linear, overwhelmingly logical and frankly boring. They consist of organizing by to do lists which are, in some cases, merely straight lists of assignments done without any prioritizing.

The right brain systems are more visual and emphasize visual systems for organization that are based on using visual cues to attain organization.These systems will tend to use color or other visually striking ways to organize information. Mind mapping is a new and highly effective strategy for using visual techniques to improve organization and planning. It’s available for computer use from a variety of free downloads including http://freemind.sourveforge.net.

For people who are highly visual, mind mapping or color  coding are likely to be more effective strategies for organization. These are also the kind of people who do not do well with file cabinets and other linear organization strategies. These people need to see things to be able to work with them. They need large desks with room for different piles of stuff. They are not happy nor are they effective with a bare desk and a full file cabinet. If they can’t see it, it doesn’t exist therefore they will forget about it and never get around to doing anything about it.

These people typically don’t like paper with lines, staying inside the box and other manifestations of organization. Give them a blank piece of paper and teach them mind mapping strategies and their performance will improve.

More left brained people are more comfortable with a linear language and logic-based systems, but if they have ADHD, they are going to need to make this system more interesting. There are lots of ways of doing this, but with kids now days using some electronic or digital organizer will likely be more effective.

Kids typically don’t like large clunky organizers like most of the agendas, schools issue. They want something small that will fit in a pocket and are cool or hot or whatever the current term is for something that’s fashionable. PDA’s (personal digital assistant) are an option as are most cell phones. Paper and pencil systems, like Day Timer, can also be helpful. They come with custom covers/holders that sometimes pass the cool test.

Once you’ve got the hardware, the trick is to use it regularly. You’re ahead of the game if you match cognitive style with the organization system. You still have to teach some of the basic techniques of organization such as taking big projects and breaking them down into smaller, easy-to-accomplish tasks and tracking them.

To get regular use from the system you have to check regularly and insure that your ADHD’er is using it. After 8 to 12 weeks of checking daily, you can likely back off some.

This combination of external organization, organizational strategies keyed to cognitive style and regular checking should cause your ADHD’er to internalize organization.

More information seeADHD brains — external structure.

]]> http://terrygingrasphd.com/adhd-brains-internal-structure/feed/ 3 http://terrygingrasphd.com/training-adhd-brains-structure/ http://terrygingrasphd.com/training-adhd-brains-structure/#comments Thu, 19 Nov 2009 13:49:47 +0000 TGingras http://terrygingrasphd.com/?p=53

Chaos without reinforces chaos within.  ADHD Brains are different.

ADHD kids live with chronic chaos–in their brains. Their innner experience is frequently disorganized, unfocused  and not particularly goal oriented.

When scientists look at their brain functions, ADHD kids have underactive frontal lobes  and generate more of the brain waves associated with disorganized thinking.

They, more so than other children need external structure in their lives. A chaotic home life without consistency or structure makes their internal chaos worse.

On the other hand, a home life with a structure, with routines they can depend on will help them improve their internal organization.

The brain demonstrates neuroplasticity, that is, it changes, actually changes its structure based on the demands you make on it. You establish routines for your ADHD child and eventually ( you know nothing comes fast with this group) he or she internalizes it.

You are teaching organization by demonstrating it.

Want to handle the problems of getting up in the morning? Have a routine for it and follow it precisely.

Problems with homework? Have a routine for it. This is the time you do your homework every day. This is where you do your homework every day. These are your materials to do your homework. They will be here every day.

Also, and very important for a variety of reasons,  is a  family meal time. We meet for our meal, discuss the events of the day, discuss any problems we have ( no anger or frustration from parents,please). This is a time to get to make sure we still know each other. No TV. No cell phones. No texting. No game boys.

Routines provide structure. They also provide comfort for children. Structure makes the world more predictable. Having a strong family structure also makes it easier to adapt and adjust to the structures in other environments, like school.

Eventually, with consistency structures are internalized by children. They start to expect them and eventually, they start developing their own structures/ routines.

Chaos without leads to chaos within.

Organization without leads to organization within.

ADHD brains require special handling.

T–

For more information on ADHD brains, see Training ADHD Brains-Meditation @ http://terrygingrasphd.com

When I was a boy psychologist first learning about ADHD, I thought meditation, relaxation training and/or hypnosis  should be an effective treatment because it trains the mind to focus.

One of the attempts to define hypnosis even calls it a state of heightened focus. Additionally, my patients were reporting heightened abilities to concentrate after starting one of these programs.

Unfortunately, at that time, there was no scientific research supporting the effectiveness of any of these procedures with ADHD.  Russell Barkley, the well-known researcher, specifically said meditation wsas not effective for ADHD

Well, here we are 20+ years later and we have research support that meditation is effective for reducing ADHD symptoms.

There are several studies available, mostly researching mindfulness meditation. There are even studies utilizing functional MRI to document brain changes–increased thickness and density ( these are good things for your brain indicating increased capacity in the area that’s growing).

Mindfulness meditation is a technique that focuses on increasing awareness of basic sensory information, as in breath mindfully. This technique involves focusing on your breathing and constantly redirecting your attention back to your breathing when it starts to wander.

The technique involves calmly redirecting your attention with the expectation that you will gradually find it easier to stay focused.

There are all sorts of variations on these techniques include the Transcendental Meditation  technique of using a focus word on each exhalation. And most of us have heard of the all-purpose “Om” spoken out loud as an aid to meditation.

Mindfulness meditation has been demonstrated to alter attentional networks, change EEG patterns  and change dopamine (neurotransmitter ) levels.

Practically, meditation is easy to understand, somewhat more difficult to do. Surpisingly, (to me anyway) I have had reasonably good results in my private practice with this technique.

It requires no equipment although some simpler biofeedback equipment, such as the Heartmath  EmWave Personal Stress Reliever may enhance the effect and make compliance easier.

If you decide to use mindfulness meditation you should find a qualified instructor at least initially. It should be someone with specific training in meditation and ADHD such as your basic baby boomer psychologist who was exposed to all the meditation techniques back in the 60s.

Pick somebody with training and credentials. The nice exercise instructor reading a technique out of a book after an exercise class is not a good choice.

Meditation is an  effective technique and needs to be taken seriously. It will be worth it  in the long run.

T–

For more information on ADHD, see Training the ADHD brain–computerized cognitive retraining @ http://terrygingrasphd.com

Another drug-free approach to improving cognitive performance is neurofeedback.

It is a biofeedback methodology that gives the individual feedback about the kind of brainwaves being generated and trains the individual to produce the appropriate brain waves.

The brain waves associated with focused attention are called Beta. The brain waves associated with disorganized thinking are called Theta. With ADHD clients , we’re training the patient to increase Beta and decrease Theta.

This change, increasing Beta and decreasing Theta, eventually becomes permanent. This leads to consistently improved control of attention, with less time being spent in relatively disorganized mental states.

We could go into more detail, outlining all the different brain waves and their frequencies, but the basic premise is the same–if you have ADHD, Theta bad, Beta good.

If you’re from the 60s or 70s ,  the only brain wave , you have probably heard of is Alpha which is associated with calm, peace and relaxation. There are many approaches to generating Alpha, but there is not consistent reasearch suggesting that alpha training is beneficial for ADHD.

Treatment takes about 30 sessions.  Improvement  i n ability to concentrate and control behavior is thought to be permanent. A session lasts about 45 minutes.

The patient has electrodes stuck to their scalp in various precisely measured locations. This sounds really bad but is about the same as putting tape on the scalp. It is totally painless. The electrode has a small cavity that is filled with electrode gel–a sort of sticky substance kind of like chapstick, that improves electrical conductance. Understand the electrodes are passive receivers, they do not send electricity into the brain, they merely measure the electrical impulses that the brain is producing.

Although this procedure–geting hooked up–can take a little time, most little boys kind of enjoy the process. After hook-up they wires coming off their scalpto the machine. In my clinic, we use a wireless system that allows  a lot of movement without pulling the electrodes off.

Treatment sessions normally consist of learning to control brain waves, while watching videos or listening to audio cassettes. (The speed of presentation and , indeed, whether it is presented at all is controlled by the patient’s brain waves.  If the patient is meeting the training criterion, the dvd or cd plays normally. Fall out of criterion and they slow or stop.)

We use a system that allows us to combine neurofeedback and cognitive retraining as well as play games and do dvds or cds. This makes sessions relatively enjoyable and pleasant.

It takes 15-20 sessions before much progress is seen. Most treatment protocols go to about 30. Research is solid and generally supportive of neurofeedback.

It is definitely a treatment approach that you should consider.

T–

For more information on ADHD treatment, see Trainiing the ADHD Brain–computerized cognitive retraining @ http://terrygingrasphd.com

Training the ADHD brain to better control attentional processes is now possible and it doesn’t require medication. Your child or husband can learn to improve attention, consistency and behavior by exercising his or her brain with computerized cognitive retraining.

CCR has  two major features–1. it involves training based on neuroplasticity and 2. it is  not medication-based.

Neuroplasticity is the exciting discovery that the brain is malleable. It changes in response to the demands we make of it. Like doing biceps curls makes your arm muscles bigger, doing attention exercises makes the part of your brain responsible for attention bigger. This allows  you to better control your attention.

CCR involves doing different mental exercises, sort of brain calisthenics to improve certain cognitive (thinking)  functions. These techniques have been available for at least 25 years and have been consistently improved. They are effective, safe and have no side effects. You can improve attention, working memory, auditory processing, speed of processing, almost any cognitive process.

You should see noticeable results within 20-30 sessions. Most treatment protocols are for 30 sessions. Its kind of like playing video games, but you can tell its designed for more than just fun.

Both children and adults can be treated effectively. I just finished treating a 26-year-old woman who received 30 sessions of treatment–2 per week — and had significant improvement in auditory and visual attention and working memory. She decided to have treatment because she wanted to have children and didn’t want to be pregnant and on medication.

We have also seen significant results with children as young as six.

Its important to understand that CCR will improve cognitive efficiency regardless of medication. Some parents want to avoid or minimize medication use and CCR will be helpful for that.  Some parents want to improve cognitive performance–think school–while keeping their child on medication. CCR will be effective in this situation as well.

I don’t want to oversell, but I have been impressed with the results we’ve achieved in my clinic and I have colleagues who have gotten similar results.

As a parent of an ADHD child or as an adult with ADHD, check out computerized cognitive retraining. It changes your brain for a lifetime and can improve your life.

T–

For more information on the ADHD brain and treatment see Training the ADHD brain @http://terrygingrasphd.com

In the years since I was a boy psychologist,we have discovered that it is possible to train people’s brains to improve attention,memory, working memory and almost every other cognitive function. More recently we’ve discovered that it also works for ADHD!

Different training techniques improve different brain functions without medication. In some cases medication is discontinued, in other cases it is considered a supplemental treatment.

There are three of techniques so far to train brains–computerized cognitive retraining (CCR),neurofeedback and meditation training. They each have a different focus and each has a base of research indicating that they are effective.

CCR-computerized cognitive retraining- is a set of brain exercises that are kind of like video games but are designed to stress the brain and increase performance. They are mental calisthenics and like weight training for your muscles, they actually increase the size and density of specific brain areas. This increases your  brain’s ability to pay attention, control impulses and function in high stimulus environments (like classrooms).

Neurofeedback or EEG biofeedback is designed to help individuals change their brainwaves. There are four different wavelengths generated by the brain. One of these, Beta, is associated  with concentration. Another, Theta is associated with disorganized thinking. ADDers are thought to generate an excess of Theta and to undergenerate Beta. Most neurofeedback treatment protocols try to reverse this and increase Beta while decreasing Theta.

This can be accomplished with regular training at a treatment center specializing in neurofeedback. Treatment protocols usually involve 20-30 sessions. Changes/ improvements are thought to be permanent and there is research supporting effectiveness.

The last brain training technique is meditation training. This is a very loosely defined area that covers mindfulness meditation, biofeedback and different types of relaxation. There is research supporting effectiveness. This approach is the most direct–if someone can’t pay attention, why not train them directly to pay attention? Only recently has there been research supporting this approach.

These are the three methods of training the ADHD brain. They all have their utility depending on individual situations. I have used all three methods for years and am impressed with the results achieved. They are all medication free and/or may effect the amount of medication required. They produce permanent changes.

In upcoming posts, I will cover each procedure in more detail. Hopefully making your decisions easier.

T–

As parents of attention-deficit-disorder (ADD) and/or learning-disabled (LD) children, we are so busy dealing with daily crises that we sometimes lose sight of what we’re trying to accomplish with our offspring. With all the hassles of getting up, getting off to school, getting books and homework assignments home and then getting them done, dealing temper tantrums and meltdowns, it sometimes seems that simple survival is the ultimate goal.

We lose sight of the fact that someday our child will be an adult. We’re so busy trying to make it through the day that we stop thinking about what kind of person we want them to be, what values we want them to have. We’re so drained that we don’t have the energy to think about the future. We tend to spend our time dealing with the present hassles, dealing with our children tactically, that is, trying to win each battle and not looking at the long-term goal.

As parents of ADD and LD children, we need to think strategically, to think about what kind of adults we are training on a day-to-day basis.

In my practice, I call this strategic parenting. By this term, I mean never doing anything on a day-to-day basis with your child without considering the ultimate outcome of parenting, the strategic outcome of parenting—namely, what kind of adult your child becomes. There are many theories of child-rearing, but most focus on short term obedience issues. They are, in a word, tactical. This is not a problem with most children. All people have a powerful drive to self-actualize and most children eventually realize that they are better off getting good grades in school and getting along with their parents.

However, this is not always the case with ADD/LD children. As many of us know and have experienced, these children have a highly developed ability to resist at extraordinary volume for extraordinary lengths of time. Therefore, parents have to resist the temptation to respond tactically and try to win the battle. They have to get outside of the emotional battle and think about the strategic goal: what value or personal characteristics are we trying to teach?

Think about what kind of adult you want your child to become. What kind of values do you want him/her to have? What beliefs? What personal characteristics?

Presumably, you want a person who is more than just obedient. Probably, you want a person who is enthusiastic, creative and feels good about her/himself. You want a person who is confident enough to make the most of his/her talents and abilities. There is more to life than just being compliant in school. There is more to life than just a clean room. As parents we have to hold the larger picture and work to teach our children.

At a conference in Washington, D.C. in 2000, one of the presenters (name is lost in the mists of time) reported on the characteristics of ADD and LD adults who were termed successful. These characteristics for successful adjustment to the adult world are a starting point as the goals of strategic parenting. These characteristics had nothing to do with how much education they had, how severe their disabilities were, how high their IQ was or how rich their parents were. The assets of successful ADD and LD adults are all psychological characteristics that have to do with making the most of your abilities.

These characteristics are:
1. Self-Awareness
2. Perseverance
3. Being Proactive
4. Having Emotional Stability
5. Being Able to Set Goals
6. Being able to appropriately use Support Systems

In other words, these successful people acknowledged and understood their disabilities, recognized when they would get in the way, used appropriate compensatory strategies to minimize the impact. Had learned to be good planners and set goals. Were persistent in getting to these goals and didn’t let emotion get in the way.

These characteristics are all learned. They can all be taught.

As parents of ADD/LD children we must think strategically about our children. We must learn to teach the characteristics that lead to successful adulthood. We must remember that psychological strength is the most important goal of parenting. Additionally, one of the side benefits of strategic parenting is that we can enjoy our children more because we have to appreciate and encourage their talents, their abilities and their uniqueness.

Good luck and never give up,
Terry

Studies on children with ADD/LD who have grown into successful adults list a variety of characteristics and skills that are essential. They boil down to three essentials

1. Positive self-esteem
2. Effective support systems
3. Skills to set goals and cope with emotions.

In this post, let’s focus on the first element, positive self esteem.

Positive self-esteem –

Positive self-esteem involves self-awareness and self acceptance including one’s ADD/LD. This involves appreciating and being aware of one’s strengths and weaknesses and being accepting of both. It involves having the belief that one is capable and can solve and handle whatever problems come our way.

As a result of this basic belief, one also is persistent. One does not give up, one keeps trying.

A positive self-image can be trained. It requires a positive environment with lots of encouragement. It also requires the chance to succeed or fail and the encouragement to recover from mistakes

Effective support systems –

Effective support systems refers to the people in our lives who encourage us when we are down. It also involves people who help us compensate for our weaknesses or disabilities. This is the classic disorganized ADHD husband with an organized wife or the disorganized ADHD businessman with an organized secretary. Having these systems in place and knowing when to utilize them are important aspects of becoming a successful adult.

Skills to set goals and cope with emotions –

Children with ADD/LD need to learn how to set goals. That tendency for an ADD/LD child is to be overwhelmed by tasks. Whether it is a school term paper or cleaning the garage, they tend to have difficulties with setting appropriate goals, breaking these down on the subgoals and accomplishing the little bit at a time they need to feel successful.

They tend to look at it all as one big undifferentiated task and get overwhelmed. It’s vitally important that they are trained in breaking big projects down into little tasks. It’s also important that they learn to take credit for accomplishing little tasks. ADD/LD kids tend to be negative about themselves and their abilities. That is one of the reasons they tend to give up too easily. It takes conscious training to overcome this.

Coping with emotions involves the basics of stress management. One has to be aware of one’s responses to stress, be able to monitor them and have appropriate coping strategies. ADD/LD kids tend to not be aware of their emotions and tend to not have appropriate ways to cope with these emotions. Therefore, they tend to ping off the walls and then explode usually in anger. Awareness of emotions can be trained in. With young children, it initially involves the parent recognizing and identifying the child’s emotion. The parent also models acceptance and indicates appropriate coping strategies.

These are the basics of the three main goals for the parent of an ADD/LD child. Helping your child develop a positive self-image, both helping him develop and being part of his support system and coaching in the skills of goal setting and coping with stress and frustration. Keeping these in mind at all times will keep you an effective parent who will raise a successful adult.