Reporting in on Cogmed success (working memory)

[Laurie4b]

We had some life events interfere with our decision to pursue Cogmed with our ds 15 who is ADD. He was spending so.much.time. on school and getting almost nothing done. He just couldn't concentrate. When I had the time, i would sit right next to him to lend some "executive functioning" and make sure he didn't get off task, and it still took forever.

 

For background, it used to be thought that working memory couldn't be changed, except for training it for a specific task, but that it wouldn't generalize. Then a researcher in Sweden designed a computer program to see if it could. With a double-blind study with normal (adults I think), it did change and it did generalize. Then they did a double blind study on ADHD kids--in England I think, and it improved in that population, too. A couple years ago, I read about it and wished it were available for the general public and not just researchers. Then I found out it is. It's called Cogmed and it is a computer program to improve working memory. Several studies have been /are being done with it at this point, including for kids with cancer to see if they can recoup some of the cognitive changes that can come from chemo. To find double-blind studies on a product that addresses is so unusual for something in this field.

 

There has been some shifts in thinking about the chicken and the egg in ADD. It used to be thought that people with ADD were more easily distracted than others and that the distractibility impacted working memory. Now the thinking is reversed: that a low capacity working memory causes the problems with distractibility. So kid with a good working memory is doing school and his attention is drawn to something outside. He looks. So does the kid with ADD. However, when the distraction is done, the kid with a good working memory still has what he had been doing in his working memory; that data has been wiped out of the ADD kid's working memory by the distraction, so he gets up and gets a snack. :tongue_smilie:

 

So we are on week 4 of Cogmed and have started seeing some real changes! The first was that ds says he can now tell when he's off task. (Yes, it was that bad. He's the guy getting up to get the snack with every good intention of finishing that algebra assignment. After the snack, it's outside and.... I honestly did believe him before when I would say for the millionth time,"What are you supposed to be doing!" :glare: and he would say, "Oh! (on seeing me. I'm a giant walking memory CUE. ) I forgot." And back he'd go. So having him have enough working memory to be able to self-monitor was huge.

 

Then Sat, I said he needed to finish the assignments I had just found out he hadn't handed in for his outside chem class. This could have taken all day, but he was done in about an hour--and without me prompting, reminding,etc. Then, to my total amazement, I came home late from church Sunday and he had already looked up his reading assignment for an outside class on Tuesday and had done it! That night he came home from youth group and got out another book for another assignment and started to read it. :svengo:

 

That should be SO normal for a kid his age, but he just couldn't do it before.

We are :party: and thanking God for this!

 

We still have another week of the research protocol left. (5 sessions of about an hour per week for 5 weeks.) There is a follow-up program of 20 min. sessions 3 times per week for the rest of the year if we want it, but the efficacy of the follow-up hasn't been tested in the double-blind studies yet.

[Tokyomarie]

Thanks for letting us know how it's going. I was wondering how things went with the Cogmed. I attended a session about it last fall- our neuropsychologist's office is now offering it and was presenting about it at a local meeting.

 

I am really trying to puzzle something out, though, for our son. He has the same behaviors you've mentioned in your post- can't get schoolwork done unless I'm sitting next to him & helping him to stay on track- particularly work that involves written output. He's 17yo! He also has lots of those, "Oh, look, a shiny over there," moments of distractibility. However, his working memory tests in the average to slightly above average range. 1.5 years ago, his working memory tested dead set average but processing speed was relatively lower. During an eval we recently had at another facility, they used his good working memory scores as one indicator that he can't be ADHD. He's not hyper, but is distractible on work not of his choosing; when he was younger he showed some physical impulsivity, though never of a dangerous type. He plays video games (doesn't make me happy- his dad does them with ds) and I'm wondering if playing the ones that require more strategy have built up his working memory over the years. I can think of examples from when he was younger of situations where his academic performance issues were possibly impacted by poor working memory.

 

In any case, I'm wondering where these behaviors come from if it's not ADHD. I know the folks who concluded he can't have ADHD seem to think it's my poor parenting, especially since I homeschooled him. :rolleyes:

[Sandragood1]

My dd, 9 at the time, tried Cogmed for st memory problems associated with add. After the initial day or so she was miserable and crying about doing it. I think the learning curve was too steep for her.

 

I wonder whether your son being somewhat older helPed?

 

We also got very little support from the provider which may have made an impact.

 

I'm curious if anyone has had benefit from cogmed with tweenagers?

 

 

Sandra

[Laurie4b]

My dd, 9 at the time, tried Cogmed for st memory problems associated with add. After the initial day or so she was miserable and crying about doing it. I think the learning curve was too steep for her.

 

I wonder whether your son being somewhat older helPed?

 

We also got very little support from the provider which may have made an impact.

 

I'm curious if anyone has had benefit from cogmed with tweenagers?

 

 

Sandra

 

The psychiatrist who is the provider showed us a graph of how much benefit each age gets from it. IIRC, early teens had the very highest benefits. It drops off into adulthood, but there is still some benefit. I don't recall what I saw before the teen years. Our provider is great. She keeps in really good touch by email and answers any questions extensively.

[PeterPan]

Laurie, just for my curiosity, had you tried Luminosity before this? It was the cost of Cogmed that really got me.

 

Marie, there are estimates that ADHD is mis/over-diagnosed in about 50% of the gifted population. The symptoms are almost identical. I think you're right that video games can up their working memory and processing speed, which is why I got my dd a Wii. But it sounds like what you've gotten are what our OT called "splinter skills," where you have something made stronger by specific practice and the entire rest of the package still symptomatic. Since EF is in a part of the brain, not just one dot, it makes sense to me that that could happen. What you want is to carry that working memory over to other tasks in the brain and start developing those connections. The Linguisystems workbooks on EF might make a lot of lightbulbs click for you on how to do that. Or Yllek has had some great ideas. For instance, Yllek has described a task her in ds's speech therapy where he has to identify pictures (tasking his language side), remember the order (working memory), and make specified marks by each one (writing). So there you've got different problem areas all being worked in one task. I've been doing it with my dd and like the progress I'm seeing.

 

Sandra, if the Cogmed wigged her out, she might need some OT first. Sensory issues can impact attention and make it harder for the working memory to work. Our OT put it that the sensory problems are a fire alarm going off while the dc is trying to do his math. The OT doesn't make the math any easier, but it turns off the fire alarm. And with that fire alarm off, the dc has a better chance.

[Crimson Wife]

Thanks for the update! Cogmed is one of the programs I'm keeping in mind as a possibility for my oldest DD when we finally get some room in our budget to deal with her 2E issues instead of the youngest's autism. Right now we're not sure whether oldest DD has problems with auditory processing, attention, working memory, or some combination. If we won Powerball, I'd probably have her do Cogmed and Fast Forward and maybe some AIT as well.

[Tiramisu]

Laurie, just for my curiosity, had you tried Luminosity before this? It was the cost of Cogmed that really got me.

 

Marie, there are estimates that ADHD is mis/over-diagnosed in about 50% of the gifted population. The symptoms are almost identical. I think you're right that video games can up their working memory and processing speed, which is why I got my dd a Wii. But it sounds like what you've gotten are what our OT called "splinter skills," where you have something made stronger by specific practice and the entire rest of the package still symptomatic. Since EF is in a part of the brain, not just one dot, it makes sense to me that that could happen. What you want is to carry that working memory over to other tasks in the brain and start developing those connections. The Linguisystems workbooks on EF might make a lot of lightbulbs click for you on how to do that. Or Yllek has had some great ideas. For instance, Yllek has described a task her in ds's speech therapy where he has to identify pictures (tasking his language side), remember the order (working memory), and make specified marks by each one (writing). So there you've got different problem areas all being worked in one task. I've been doing it with my dd and like the progress I'm seeing.

 

Sandra, if the Cogmed wigged her out, she might need some OT first. Sensory issues can impact attention and make it harder for the working memory to work. Our OT put it that the sensory problems are a fire alarm going off while the dc is trying to do his math. The OT doesn't make the math any easier, but it turns off the fire alarm. And with that fire alarm off, the dc has a better chance.

 

Elizabeth, Could you post a link for the Linguasystems EF workbook?

 

Talking about wigging out, I wonder if Cogmed would be a good fit for sensory kids who tend to have low frustration tolerance. It's not a fair comparision, but when we tried the writing 8 exercise, it annoyed dd#2 to no end. She obviously needs something, but I don't know if we'll get that to work. I have resorted to bribery, though.;)

[Laurie4b]

Laurie, just for my curiosity, had you tried Luminosity before this? It was the cost of Cogmed that really got me.

 

Marie, there are estimates that ADHD is mis/over-diagnosed in about 50% of the gifted population. The symptoms are almost identical. I think you're right that video games can up their working memory and processing speed, which is why I got my dd a Wii. But it sounds like what you've gotten are what our OT called "splinter skills," where you have something made stronger by specific practice and the entire rest of the package still symptomatic. Since EF is in a part of the brain, not just one dot, it makes sense to me that that could happen. What you want is to carry that working memory over to other tasks in the brain and start developing those connections. The Linguisystems workbooks on EF might make a lot of lightbulbs click for you on how to do that. Or Yllek has had some great ideas. For instance, Yllek has described a task her in ds's speech therapy where he has to identify pictures (tasking his language side), remember the order (working memory), and make specified marks by each one (writing). So there you've got different problem areas all being worked in one task. I've been doing it with my dd and like the progress I'm seeing.

 

Sandra, if the Cogmed wigged her out, she might need some OT first. Sensory issues can impact attention and make it harder for the working memory to work. Our OT put it that the sensory problems are a fire alarm going off while the dc is trying to do his math. The OT doesn't make the math any easier, but it turns off the fire alarm. And with that fire alarm off, the dc has a better chance.

 

No, we had done Brainware Safari and it was helpful to a degree. I've wearied of sinking time and $$ into interventions based on hopeful anecdotal evidence but which lacked a research base, so when I discovered that there was actually an intervention with double-blind studies, that's what I chose.

[Sandragood1]

OhELizabeth or anyone else,

 

Regarding OT, where do I begin? My fear is that if you ask a [specialist] whether you need that [specialty], they will always say yes.

 

I guess I'm a bit jaded after this long. Between the two kids, we have done speech therapy, auditory therapy, handwriting OT help, vision therapy, biofeedback, CogMed, diet modifications, supplements, prescriptions,.... All while supporting interests (soccer, dance, ice skating, piano, etc) that I also consider to be therapeutic.

 

For dd, I KNOW, we are still missing something. We did a complete education/intellect evaluation, which resulted in the CogMed recommendation and dx of a number of a number of issues. Maybe OT would help, but how do you find a good one?

 

Sandra

[PeterPan]

OhELizabeth or anyone else,

 

Regarding OT, where do I begin? My fear is that if you ask a [specialist] whether you need that [specialty], they will always say yes.

 

I guess I'm a bit jaded after this long. Between the two kids, we have done speech therapy, auditory therapy, handwriting OT help, vision therapy, biofeedback, CogMed, diet modifications, supplements, prescriptions,.... All while supporting interests (soccer, dance, ice skating, piano, etc) that I also consider to be therapeutic.

 

For dd, I KNOW, we are still missing something. We did a complete education/intellect evaluation, which resulted in the CogMed recommendation and dx of a number of a number of issues. Maybe OT would help, but how do you find a good one?

 

Sandra

 

You'd be looking for an OT that does sensory. Read "The Out of Sync Child" first though. There's a LOT you can do at home. Invest in a single line swing, get/make a weighted collar, and boom you're doing something pretty common in the therapy sessions at home. For the cost of one therapy session you can buy your own swing.

 

I do think the eval is helpful, and if I had been using someone who had been more of a once a month, homework model, we would have kept going. Instead we were getting leached for things we could have done at home with a little instruction. So it's something to look into if you read The Out of Sync Child and think you're onto something, but that doesn't mean you need to do it every week like they say. That can be great, but you can also find people who will work with you on more flexible schedules. I just didn't realize that going in.

[PeterPan]

Kelli, start with this one http://www.linguisystems.com/products/product/display?itemid=10697 As far as Cogmed, that's a lot of money to plunk out if you aren't sure your dc is up to it. You might start with something less expensive but similar (luminosity, brain ware safari, whatever) to see how they respond. I grant Cogmed is better (our np recommended it too), but at $1500 that would be a pretty expensive mistake, kwim?

 

On those 8's, I really had to back up and break it down. You're crossing the midline. I stopped watching after a while, but I think dd makes them screwy, sort of backwards or something. It's sort of an oddball shape to make. If you make the 8 like that, can she TRACE it? (no handwriting, just the 8 itself) Maybe practice that first. Takes a lot of motor planning then to start putting letters onto it. If she can't do that, then back off and find something easier, a precursor. I'm just drawing a blank as to what that would be.

Edited January 19, 2012 by OhElizabeth

[mamakelly]

We had a therapist suggest Cogmed for my husband (I really think he needs it...) But the cost was a little intimidating, especially when we are currently doing VT with a second child. We ended up going with Lumosity for now. I know it's not the same, but they did have a family plan, so everyone including dh is doing it. I'm definitely keeping Cogmed on my mind for DH after we finish VT with Blake.

[Terabith]

How does CogMed compare to something like PACE? I'm trying to figure out what would help my 6.5 year old (besides vision therapy, sigh). I figure she is too young for most of the cognitive skills training programs, however.

[Tiramisu]

Kelli, start with this one http://www.linguisystems.com/products/product/display?itemid=10697 As far as Cogmed, that's a lot of money to plunk out if you aren't sure your dc is up to it. You might start with something less expensive but similar (luminosity, brain ware safari, whatever) to see how they respond. I grant Cogmed is better (our np recommended it too), but at $1500 that would be a pretty expensive mistake, kwim?

 

On those 8's, I really had to back up and break it down. You're crossing the midline. I stopped watching after a while, but I think dd makes them screwy, sort of backwards or something. It's sort of an oddball shape to make. If you make the 8 like that, can she TRACE it? (no handwriting, just the 8 itself) Maybe practice that first. Takes a lot of motor planning then to start putting letters onto it. If she can't do that, then back off and find something easier, a precursor. I'm just drawing a blank as to what that would be.

 

So far, what I've done is draw the 8, have her do three loops around starting at the intersection and going up and left, then do a letter, then three loops again, letter, etc. She can do it, but absolutely hates it. Triggers bad mood, constant grumbling. If I had to do it, I wouldn't like it, but I'd just get it done and have it over. I just don't see the big deal, but it's setting something off in her.

[PeterPan]

Kelli, remind me, have you had her eyes checked? I think when you get that kind of response with an activity, you're hitting on something.

[PeterPan]

How does CogMed compare to something like PACE? I'm trying to figure out what would help my 6.5 year old (besides vision therapy, sigh). I figure she is too young for most of the cognitive skills training programs, however.

 

Terabith, our VT place does PACE, and the feedback has been ASTOUNDING. If you have a VT place that does both, I'd definitely consider it. Ours has you do VT first. They started bringing some of the PACE worksheets into our VT time at the end, and they were *very* challenging. They work on working memory plus lots of other things in a really sophisticated way (bringing in visualization, etc. etc.). Actually, it was so challenging we had to stop. She literally hit a wall and couldn't progress with it. They told us she needed more OT. The OT was so hair brained, we stopped, meaning we never went back to finish that bit of VT. It would be a good idea, maybe someday. PACE is pretty expensive. If you have someone who has done the regular VT and says PACE would help them (and you have the money), I wouldn't hesitate.

[Tiramisu]

Kelli, remind me, have you had her eyes checked? I think when you get that kind of response with an activity, you're hitting on something.

 

She had her eyes checked last year by a regular optomotrist who does think well of vision therapy and refers patients to a COVD fellow. In fact, the local fellows' office recommended him as an excellent bet to pick anything up, and it turns out he was our regular optomotrist anyway. I asked him if he saw any signs for concern but he didn't. Hmmm. It's about time for our annual visit, I think. I could bring it up again.

 

You know with the way our life has been, I don't really want to open another can of worms, but I have been heading in that direction with my recent posts, haven't I? It seems like one crisis is handled and then another one starts. Ugh. :glare:

 

Did I tell you all that my car was totalled and I'm still paying for the dental implant procedures that aren't all done yet? I'll need a job if we're going to start vision therapy.

[PeterPan]

Kelli, if you're going to take her to an optometrist anyway and you *think* there might possibly be something going on, why don't you just take her to the COVD doc for that regular appointment? Then they could screen her themselves. Should be about the same cost, just for that regular appointment. Then you'd know for certain.

 

But you know, maybe there's nothing going on with her eyes. She's low tone, right? I think I read somewhere once that most people with low tone will have opthamaologic problems identifiable by their mid 20's. So I don't think it's an outrageous thing to be looking for, but there's always the hope it won't be an issue. My ds is clearly low tone, has my astigmatism and nearsightedness, but he didn't need any VT yet. You just never know whether the glitches will occur or not.

 

Sorry about your car. So was the dental work yours? I just went to the dentist two days ago. It's that sort of horrible thing where it costs a ton of money and isn't fun but that you *need* to do to take care of yourself. Some docs have the care payment plans or sliding scales, so don't worry about that till you get there. But if you're going to pay for a regular exam anyway, do it with the COVD doc. Then you eliminate it from your mind as an issue, kwim?

[Tiramisu]

Kelli, if you're going to take her to an optometrist anyway and you *think* there might possibly be something going on, why don't you just take her to the COVD doc for that regular appointment? Then they could screen her themselves. Should be about the same cost, just for that regular appointment. Then you'd know for certain.

 

But you know, maybe there's nothing going on with her eyes. She's low tone, right? I think I read somewhere once that most people with low tone will have opthamaologic problems identifiable by their mid 20's. So I don't think it's an outrageous thing to be looking for, but there's always the hope it won't be an issue. My ds is clearly low tone, has my astigmatism and nearsightedness, but he didn't need any VT yet. You just never know whether the glitches will occur or not.

 

Sorry about your car. So was the dental work yours? I just went to the dentist two days ago. It's that sort of horrible thing where it costs a ton of money and isn't fun but that you *need* to do to take care of yourself. Some docs have the care payment plans or sliding scales, so don't worry about that till you get there. But if you're going to pay for a regular exam anyway, do it with the COVD doc. Then you eliminate it from your mind as an issue, kwim?

 

Our regular optomotrist exams are free. And the dental work was mine. All because of that evil hamburger patty I bit into over a year ago which broke my nice little tooth and killed its nerves, right in my smile line. Basically, my dentists warned me with the damage I had--which caused me to develop an infection, which caused me to lose bone--would over time affect neighboring teeth. So to prevent me from becoming even more toothless, I decided go the implant route and have had two surgeries which haven't been covered by insurance. The extended antibiotics for the infection caused CDiff and put me in the hospital, so I'm paying off the copay for that, too. And....no lawyer will take on this case because I don't have a receipt. The permanent fake tooth should be attached in a couple of months and perhaps I will be somewhat restored to my prior beauty. Then I'll have to pay for that and pray I don't have to take antibiotics again, but I bet I will. Poor, poor me.;)

 

Ahhh, a nice day for a vent.

 

Is astigmatism a reason for concern when it comes to a need for VT? Dd has one. I no longer see the tone issues I saw with dd when she was younger and the OT picked up the weaknesses. Hyperextension still there to a degree. Now, dd has never had a problem reading, though I would say her auditory comprehension exceeds her reading comprehension. That might vary though depending on whether she *liked* what she was listening to or reading. Now with your dd, you saw problems with reading small print. Is that right? What else might I see to indicate a reason for VT, besides the writing issues we're having?

[PeterPan]

Wow, I hadn't heard your hamburger saga. How horrible!!! And like you'd have a receipt for a burger??? Well at least it will be over soon.

 

People vary. My dd has no worse vision than I do or did at that age, but I have very little issues with vision stuff (just some issues with peripheral), while dd had minimal issues with peripheral and was junk on everything else. So you just never know. I'm not sure if the issue is that the astigmatism causes the problems or goes along with problems or what. Dd and I both also have this thing with our optic nerves. I forget what it was. Interestingly, astigmatism is associated with a higher rate of headaches and migraines.

 

What to look for? Well if it's free at the regular, can it be free at the COVD doc? I mean just for an equivalent, regular eye exam, not the multi-hour, full developmental exam. Then they could just screen her and tell you upfront if she would benefit from the full. I think the COVD site or other places would have better lists. Like I said, there could be something or nothing. I'd just google for those lists and see what you think.