Pondering the effectiveness of working memory programs...

[nature girl]

So since our conversations this week, I've been doing a fair amount of research looking for any proof that these programs actually help. It looks like all claims are unsubstantiated, except for CogMed. And I found a meta-analysis that similarly found that only CogMed had benefits long-term, and even then only in a couple of areas. http://www.apa.org/pubs/journals/releases/dev-49-2-270.pdf

 

I'm trying to figure out why that would be...I've looked at samples of CogMed, Jungle Memory and Jungle Rangers, and it looks like they're basically doing the same thing, although Jungle Memory and Jungle Rangers have more bells and whistles to make them more engaging. They also add distractions, to help kids learn to train their focus. So why wouldn't they be as effective?

 

I had Anna try a few of the CogMed games (they have a sample on their website) and after 3 games she was just done. There's no way she would do this for a half hour 5 days a week. (Probably not even once...) The other programs I could see holding her attention. I know MistyMountain said Jungle Memory was effective for her ds, but I'm hesitant to spend money and time on something that's not actually proven to be effective. If they actually worked, wouldn't they have double-blind studies to prove it, and be more widely recommended for all kids with wm issues?

[OneStepAtATime]

I have no answers but I am sending you good wishes and hopes for some answers.

Edited February 13, 2016 by OneStepAtATime

[Crimson Wife]

One of the posters here (OhElizabeth perhaps?) posted links last year about how CogMed has not been proven effective under a certain age (8?) I forget exactly how old it was but it was definitely older than 6 since my DD was 6 at the time.

 

The preschool/primary version of CogMed is only 15 minutes per day according to the NP I spoke to about trying it. But it's still a LOT of money to be spending since it has to be overseen by a licensed psych.

[PeterPan]

Bingo.  At the time our private np suggested Cogmed, I went on their (Cogmed's) website and found a fresh study saying it just wasn't effective up through age 7.  When I called the bigwig Cogmed psych in town, he said he usually doesn't recommend starting it till 8.  But think about it.  You're using a visual medium that is totally motor planning (mouse control) dependent for response.  Some kids are ready, some aren't.  

 

So I don't think it's indicative of what CAN be done so much as whether that particular methodology is, in general, the best choice with that age.  I'm sure you'll have outlier kids who are stellar with a mouse and computer at 6 and others who can't even begin to do that.

 

I think the lack of evidence is all about money.  Everyone knows therapy is most effective when it's (and I forget the words, but they have precise terms) but basically INTENSIVE was one of them.  Work 5 minutes, but be like BAM, BAM, BAM intensive.  So OF COURSE she wore out.  Hard medium for her age and hard work, and she wore out.  It doesn't mean it's BAD.  To me it means just the opposite!  Means she either needs a different medium, or she's struggling with the tasks, or both.  Software that's easy would be pointless.  Cognitive therapy has to stretch and it needs to be intensive.  If it's a walk in the park, you're probably not getting all the benefit you *could* be getting.  

 

But, you know, we turn around and recommend games.  But they're intensive in their own way.  :)

 

Cogmed is $1600 for the round of it in our area.  The psych does next to nothing, rakes in $$$, and gets to pat himself on the back that he did the kid some good.  Whatever.  The more interesting question is how the results STICK.  I think it was SpyCar who looked into this and cynically ended up concluding that whatever you used in real life as a result of having your expanded skills is what would stick.  In other words, you can work all you want, but the only stuff that will stay is what you use.  

 

My main suggestion is find multiple ways to work on it, and work on it for 5 minutes at a time, multiple times a day.  That's intensive but in a non-wearying way, and there's enough variety that you're hitting a variety of modalities, making it a skill that's strong across situations, and you're keeping it from getting boring.  So do some kinesthetic stuff where you give instructions and have them repeat them back and do it.  Do your more typical things like digit spans (plus metronome!) and n-backs.  And then do games.  Those three categories, applying creativity within them.

 

If you want to do software, knock yourself out.  I don't have $1600 to burn, so I've never tried it.  I think they're fine for what they are, but they're also not the ONLY way to do things.  They're just a convenient way to get that intensity.  

 

What's really interesting, in the case of our kids, is how to work on the inhibition/impulsivity thing.  Working memory, we can build that.  Inhibition though can be structured into software really easily.  How can you work on that in real life?  Think about how much our lives would get easier if our kids had a little more inhibition, lol.  I'm sure you'll find activities for it in most cognitive software packages.  But to work on it in real life?  Haven't really figured that out.  The metronome work gets you CLOSE. 

[MistyMountain]

http://scottbarrykaufman.com/wp-content/uploads/2014/08/au-et-al2014_nback-training-gf-meta-analysis.pdf

 

 

I researched this when I was deciding on Jungle Memory. There were studies that said it did not transfer and I remember some if them included cogmed too. The studies were not perfect though and there was not a lot out there that looked at those specifically. I also found the above meta analysis. I decided to give it a try because working memory is an area that can be improved and in my kid's case I believe it is the biggest reason for their struggles. I tried Jungle Memory because it was easy to implement and because it was more affordable then other options. It was hard for ds and he did have to work at it. I provided him some tips but he did the problems themselves. I noticed immediate improvement once he got through hard parts. His teacher said that he has made so much improvement on things I could not even observe like his confidence and demeanor in the classroom.

 

I do not think it was about the program itself but just working to improve how much info can be stored a little later while busy working on something else and if it is hard but they eventually get through it. I do not think jungle memory would work for every kid. It would not have worked any earlier for ds because to get to the hard part for his memory he had to be able to do math he wouldn't have been able to do yet. When it got hard he would get upset but I told him that it was ok that it was hard.

 

After seeing that it really can be improved in my son and just how far reaching a change can be I am definitely looking to find other ways to work on it especially in games. All my kids have the profile of a weaker working memory and processing speed then other areas and it manifests in different ways. My youngest is too young for jungle memory so I want to find other ways for her but I am not good at coming up with my own stuff. It needs to be clearly laid out. I think that it can be improved even in younger kids but that what is out there just is not effective for younger kids.

Edited February 13, 2016 by MistyMountain

[nature girl]

Sorry, just getting back to this. I guess my hope was that it might be even more effective if started earlier, that there'd be more neuroplasticity...I also looked through a couple of studies linked in the meta-analysis, one for ages 8 and under (I think) and the other for 4 and under, and both showed some effectiveness. But who knows...When I was trying CogMed with Anna, I was sitting with her, she'd point to where she wanted me to click and I'd move the mouse and click for her, so that wasn't the problem, it was more an attention issue. The games just aren't that fun...Maybe Jr. would be more fun, but yeah it's not worth the money if there's no proven benefit.

 

I guess we'll add in games every day, and see if that gets us anywhere. (By why would board games be more effective at this age than computer games that basically do the same thing? Or do the CogMed people only recommend it at 8 because of the attention and motor aspect?)

 

What's really interesting, in the case of our kids, is how to work on the inhibition/impulsivity thing.  Working memory, we can build that.  Inhibition though can be structured into software really easily.  How can you work on that in real life?  Think about how much our lives would get easier if our kids had a little more inhibition, lol.  I'm sure you'll find activities for it in most cognitive software packages.  But to work on it in real life?  Haven't really figured that out.  The metronome work gets you CLOSE. 

 

I think doing digit spans or whatever while they're playing should work on that, no? Or having music or an audiobook in the background? Or am I misunderstanding what you mean by inhibition? There are games too that might work on regular impulsivity...If I'm remembering right, there are games in the Bugs and Buttons series that might work, like you have to ONLY click on the bees and not the wasps, then only the bees not touching flowers, that kind of thing. But I have to wonder whether that carries through to real life, if they're really learning anything.

 

An interesting sidenote I've been thinking about, although I think Anna has issues (I think) with visual WM, she can recreate pictures really well without looking at them. Like we'll read a book, and ten minutes later she'll be able to draw one of the pages, complete with the color of the clothing the character's wearing. Does that mean her wm isn't as bad as I'm assuming? Or maybe she's using her broad attention to both study the picture for the seconds we're on the page and listen to the story...If you asked me to recreate the picture though, I wouldn't even know where to start.

[Crimson Wife]

Inhibition and impulse control is a big part of my DD's ABA program. They work on it through mostly through games like "Red Light, Green Light", "Simon Says", and "Freeze Dance".

[Bookworm4]

I haven't looked much into Cogmed to answer specifically about age 8 with that program, but I know from other readings (the only one I can remember off the top of my head is the book Smart Moves: Why Learning is not all in your Head, but I know I've read other materials that discussed this as well) I have read  that there is a lot of brain development and vision development that happens near that age.  Even understanding logic better changes around that age.  I remember Smart Moves: Why Learning is Not All In Your Head discussing how the brain processing images from electronic screens differently before age 8 as well.  I know I can see a big difference in what my DD can handle or understand at different levels now at age 8 than what she could even at age 6.  She still struggles with attention though and I don't know if her attention has improved at all now vs. a year or two ago. 

 

Your DD sounds similar to mine with visual memory (based on here and another thread).  She can remember great details of pictures (better than me) and other things in 3D or that she can visualize in 3D.  However, remembering printed letters in 2D is a completely different story (like in copywork or even remembering which direction a letter or number is supposed to face).  I remember something about this discussed in the Dyslexic Advantage in their M strength section, but don't remember enough specifics to explain it (I just remember thinking that they were explaining my DD).  I'm not assuming or suggesting that your DD has dyslexia, that book was just the first place that I read something that talked about remembering 3D vs 2D images differently and it helped me understand DD better with some of her struggles in that area and it is something I will go back and read again in the near future.

 

I don't have any advice.  I am following along still learning and trying to find more options for my DD as well.

 

 

[PeterPan]

Inhibition and impulse control is a big part of my DD's ABA program. They work on it through mostly through games like "Red Light, Green Light", "Simon Says", and "Freeze Dance".

Crimson, why are things always so obvious when you say it that way?   :lol:   I feel like a dope not to have thought of it.  I knew they were doing those things in the gymnastics classes and that they were good for him (games to cause false starts they have to inhibit, etc.), and it hadn't occurred to me to do them at home!  I had just been thinking in terms of software or slapping cards or something.  And I did NOT know that got woven into ABA.  It makes total sense.  Thanks for sharing!  :)

[PeterPan]

AM, what you're describing are visual processing skills.  She sounds very VSL.  Google it.  It's a great strength to have.  :)

[Crimson Wife]

Crimson, why are things always so obvious when you say it that way?   :lol:   I feel like a dope not to have thought of it.  I knew they were doing those things in the gymnastics classes and that they were good for him (games to cause false starts they have to inhibit, etc.), and it hadn't occurred to me to do them at home!  I had just been thinking in terms of software or slapping cards or something.  And I did NOT know that got woven into ABA.  It makes total sense.  Thanks for sharing!   :)

 

Every child's ABA program is going to be different because no two kids "on the spectrum" experience the same symptoms. My DD's program has it because that's an identified area of weakness for her but other kids at the same center may not have it in their programs.

 

One of the advantages to going through a long-standing agency with multiple clinics is that the BCBA has a centralized database of tasks from which she can pull in designing a child's program. The VB-MAPP and ABLLS testing will identify areas of weakness and then the BCBA can simply search the database rather than having to figure it out from scratch.

 

I'm sure there are resources available that a parent could use to help design an effective DIY program but since I've got the insurance coverage for ABA and a lot of other things on my plate, it's not something that I've looked into.

 

[nature girl]

Inhibition and impulse control is a big part of my DD's ABA program. They work on it through mostly through games like "Red Light, Green Light", "Simon Says", and "Freeze Dance".

 

That makes sense...She's actually quite good at those games (or she was years ago when we used to play them) didn't have any issues stopping those types of impulses, but in real life she definitely has issues. She tested in the normal range for impulse control during her eval, but I'm not sure if that translates...All they did was tell her to stand still as a statue, and try to get her to move by talking or waving toys, and she was able to keep herself still. So she's not HORRIBLE, I mean, she's not lighting things on fire or running into traffic, but when she gets something in her head she can't stop herself, like we have issues with her taking treats I was saving for later as soon as she sees them, without asking, that kind of thing. She also used to do some more semi-violent things, like pushing or throwing sand for no reason and having no idea why she'd done them, although we haven't had that issue since the beginning of last summer.

 

 

Your DD sounds similar to mine with visual memory (based on here and another thread).  She can remember great details of pictures (better than me) and other things in 3D or that she can visualize in 3D.  However, remembering printed letters in 2D is a completely different story (like in copywork or even remembering which direction a letter or number is supposed to face).  I remember something about this discussed in the Dyslexic Advantage in their M strength section, but don't remember enough specifics to explain it (I just remember thinking that they were explaining my DD).  I'm not assuming or suggesting that your DD has dyslexia, that book was just the first place that I read something that talked about remembering 3D vs 2D images differently and it helped me understand DD better with some of her struggles in that area and it is something I will go back and read again in the near future.

 

DD only has one reversal, her lowercase g's, which she's been writing wrong for so long that I think it just looks normal to her now, blah. I don't know where her issues with copywork come from...maybe it's not all that far off from average at her age? Maybe I'll post something on the K-8 board to see where other kids are. I don't think she looks at the shape of the letter when she copies, I think she thinks the letter name (as we would if we were copying a word we weren't familiar with.) I have no idea what kind of wm that's stretching, then.

 

 

AM, what you're describing are visual processing skills.  She sounds very VSL.  Google it.  It's a great strength to have.   :)

 

She's definitely VSL...I think I remember reading somewhere that many kids with ADHD are. (It's kind of amazing watching her follow complex Lego instructions, I'm still staring at a picture and scratching my head and she has the project halfway done already, ha.) Combined with a poor visual wm maybe that will help her compensate some? Who knows, the more I'm talking about this the more I realize I don't actually understand any of it.

[PeterPan]

AM, I think your problem then is that you don't have the right words for things.  I'm not meaning to be trite, but you can't get the solutions till you get the right words for the behavior.  Rigidity, lack of perspective taking, attention-seeking, there are other words that could describe the behaviors you listed.  She's super bright.  They might not be *merely* impulsive.  

[MistyMountain]

My ds is similar. He is very good with Legos and k-nex and he can get a strong visual in his head from listening to books. He can even picture how things like engines work and see how the parts fit together but he could not copy a whole word while doing copy work but did it letter by letter. He does reverse a lot. He is not as good at puzzles as he is things like Legos but he does not struggle with them either. He did struggle with the visual memory stuff in jungle memory. He struggles with picturing what words look like visually for spelling and I always wondered why since he usually is good at visualizing. I never realized that 3D and 2D visual memory could be so different but that does make sense and explains a lot.

Edited February 15, 2016 by MistyMountain

[Crimson Wife]

That makes sense...She's actually quite good at those games (or she was years ago when we used to play them) didn't have any issues stopping those types of impulses, but in real life she definitely has issues. She tested in the normal range for impulse control during her eval, but I'm not sure if that translates...All they did was tell her to stand still as a statue, and try to get her to move by talking or waving toys, and she was able to keep herself still. So she's not HORRIBLE, I mean, she's not lighting things on fire or running into traffic, but when she gets something in her head she can't stop herself, like we have issues with her taking treats I was saving for later as soon as she sees them, without asking, that kind of thing. She also used to do some more semi-violent things, like pushing or throwing sand for no reason and having no idea why she'd done them, although we haven't had that issue since the beginning of last summer.

 

I have to agree that this doesn't exactly sound like impulsivity per se, at least not the kind of behaviors that my DD struggles with. Fortunately the medication and ABA (plus general maturing) has helped reduce the worst of the impulsivity like bolting in traffic. But it's different than just disobedience and/or attention-seeking (which she also does). Even when she's really engaged in a game like "Red Light, Green Light" and WANTS to inhibit the impulses, it's much more challenging for her than for typical kids the same functional age equivalent.

[nature girl]

AM, I think your problem then is that you don't have the right words for things.  I'm not meaning to be trite, but you can't get the solutions till you get the right words for the behavior.  Rigidity, lack of perspective taking, attention-seeking, there are other words that could describe the behaviors you listed.  She's super bright.  They might not be *merely* impulsive.  

 

Well, she is all three of those things as well, but the hitting/throwing sand, etc. was purely impulsive, had nothing to do with trying to get attention. She'd just get an idea in her head and do it, even when she was getting attention. And then I'd ask her why she'd done it and she'd look totally bewildered and upset, because she hadn't meant to do it and had no idea why. Now her main impulse issues are with interrupting, bolting, shouting things out in co-op without raising her hand, etc...They all have other motives behind them, sure, but because of the impulsiveness she isn't able to tamp down the actions to act appropriately.

[PeterPan]

AM, here's something for you  Determining the Function of Challenging Behaviors  It's an article on the blog of Christine Reeve, the great and amazing.   :)  I mean, we keep talking about her, but she really is!  I find it hard also to see the functions of behaviors.  Sometimes it's not really obvious until you data log the ABC (antecedent, behavior, consequence) and look at it with some distance.  I'm looking at your 2nd list, and same gig.  I think these behaviors have functions you could identify.

 

You know we love you, right?  Like we wouldn't be challenging you on this if we didn't care or think there was something in it to help you.  :)

Edited February 15, 2016 by OhElizabeth

[nature girl]

Good article, and I guess I do need to start logging. But really, a lot of the time there doesn't seem to be any kind of antecedent. I'd be pulling something out of the fridge, talking to her, she'd be in a good mood, but then she'd slam the fridge door on my back. Nothing out of the ordinary happening, we're in our own home so no sensory overload, she's happy and then bam. If there are antecedents, they're just so obtuse that I don't think I'd be able to figure them out, even with logging.

 

She's actually burned herself by grabbing for food from the stove, or taking a bite out of a roast chicken I'd just removed from the oven, even though I was about to serve the meal. That's what I mean by impulsive...

 

So what would you call pure impulsiveness? Is the hot food grabbing not impulsive because it has a motivation (to eat a minute sooner?)

[shawthorne44]

Crimson, why are things always so obvious when you say it that way?   :lol:   I feel like a dope not to have thought of it.  I knew they were doing those things in the gymnastics classes and that they were good for him (games to cause false starts they have to inhibit, etc.), and it hadn't occurred to me to do them at home!  I had just been thinking in terms of software or slapping cards or something.  And I did NOT know that got woven into ABA.  It makes total sense.  Thanks for sharing!   :)

 

For some other ideas, you could look at this book.   

 

http://www.amazon.com/gp/product/0130278041?psc=1&redirect=true&ref_=oh_aui_search_detailpage

 

It is on Tools of the Mind which is about education to improve Executive Function.   You can google Tools of the Mind, the theory is old.   This book is aimed at classroom teachers.  

[PeterPan]

For some other ideas, you could look at this book.   

 

http://www.amazon.com/gp/product/0130278041?psc=1&redirect=true&ref_=oh_aui_search_detailpage

 

It is on Tools of the Mind which is about education to improve Executive Function.   You can google Tools of the Mind, the theory is old.   This book is aimed at classroom teachers.  

 

Yes, yes, I got that book through the library!!!!  It was stellar!!!  So were there things specifically on inhibition and impulsivity?  It seems like everybody takes different things from a book, and it sounds like I missed good stuff!  What really called to me at that time was the (I forget the term) mentored instruction and the idea that what they could do in *pairs* was on the path to what they could do independently and that we should not be afraid to have that paired, mentoring process.  A lot of what I was taking from it at that time was in that vein.  But if you took more from it, I'd love to hear.  :)

[nature girl]

I found an article on Tools of the Mind schools, and how they help kids learn self control. (My question is how best to use these described techniques in a homeschool setting...)

 

http://www.nytimes.com/2009/09/27/magazine/27tools-t.html?pagewanted=1&_r=0

[Crimson Wife]

For some other ideas, you could look at this book.   

 

http://www.amazon.com/gp/product/0130278041?psc=1&redirect=true&ref_=oh_aui_search_detailpage

 

It is on Tools of the Mind which is about education to improve Executive Function.   You can google Tools of the Mind, the theory is old.   This book is aimed at classroom teachers.  

 

I've read a book on Tools of the Mind ages ago, maybe for one of my psychology courses during my 1st undergrad but I don't specifically recall. The first edition of this book came out in '95 so that would've been the right era. I really like Vygotsky and the whole idea of the "Zone of Proximal Development" where the parent/teacher/therapist is trying to stretch the child by challenging him/her while providing "scaffolding" to bridge the gap between what the child can do independently vs. with assistance. I should check to see if one of the libraries here has this 2nd edition.

[Crimson Wife]

If there are antecedents, they're just so obtuse that I don't think I'd be able to figure them out, even with logging.

 

I find myself frequently brainstorming with my DD's BCBA trying to figure out why DD is doing a particular behavior. It's definitely not easy and sometimes the BCBA will need to ask the clinic director for her professional opinion.

 

It was really humbling back when we started ABA in April '14 having the BCBA and the senior behavior interventionist on the team point out (gently but directly) all the ways that we were unintentionally rewarding undesirable behaviors. It's easier now but still not easy.

[PeterPan]

I've read a book on Tools of the Mind ages ago, maybe for one of my psychology courses during my 1st undergrad but I don't specifically recall. The first edition of this book came out in '95 so that would've been the right era. I really like Vygotsky and the whole idea of the "Zone of Proximal Development" where the parent/teacher/therapist is trying to stretch the child by challenging him/her while providing "scaffolding" to bridge the gap between what the child can do independently vs. with assistance. I should check to see if one of the libraries here has this 2nd edition.

Yes, yes, those are the terms!!  It was so fascinating.  I think we had a thread on it.  I consider the way I work with ds, especially on things like K'nex, to be very in line with the ZPD thought process.  For them, what they can do with assistance, with a mentor, is indicative of skills that are formative.  They said that americans are too independent, too yes/no, too what can show on a test.  And the ZPD idea is what skills are EMERGING or formative or within reach with a mentor, even if they aren't yet doable independently.  Transfers very well into a home environment, absolutely.

[nature girl]

Oops, I meant obscure, not obtuse...

 

And yes, maybe there are things I'd need a professional to understand. But seriously, things seemed to come out of nowhere. She'd be playing nicely and happily with other kids in the sandbox and suddenly throw sand, or stomp on the castle they'd built. What could the purpose have been?

 

I don't know, I guess again I'm trying to understand what they mean when they talk about lack of impulse control as an issue with EF. Maybe we're all saying the same thing, the fact that she can't inhibit herself from the behaviors, whatever the antecedent/motivation is, is a sign of impulse issues, no? Maybe if I can figure out the antecedent and try to control it/not reward behaviors, then the lack of impulse control wouldn't affect life as often or profoundly...but that doesn't mean the EF issue goes away, not everything can be controlled for the rest of a child's life.

 

I don't know, I feel like I'm missing something here...

[PeterPan]

I find myself frequently brainstorming with my DD's BCBA trying to figure out why DD is doing a particular behavior. It's definitely not easy and sometimes the BCBA will need to ask the clinic director for her professional opinion.

 

It was really humbling back when we started ABA in April '14 having the BCBA and the senior behavior interventionist on the team point out (gently but directly) all the ways that we were unintentionally rewarding undesirable behaviors. It's easier now but still not easy.

Amen.  

[PeterPan]

I found an article on Tools of the Mind schools, and how they help kids learn self control. (My question is how best to use these described techniques in a homeschool setting...)

 

http://www.nytimes.com/2009/09/27/magazine/27tools-t.html?pagewanted=1&_r=0

Oh my, how could I have read the book and missed that?!?!  Fascinating!!  Clearly I'm going to have to revisit it.

[PeterPan]

AM, something can be done impulsively *and* have a function.  

 

In the scenario of the pretend play in that NYT article you linked, that's good stuff, but the STEPS are too big for ds.  You have to do things in little steps, with my support for my ds.  Throw him into that whole shibang and you'd have lots of behavior because he was overwhelmed.  So maybe not grabbing the pen (an action cited in the article) IS inhibition for that dc, but it wouldn't be the right small STEP in working on inhibition for my dc, kwim?  And I think if ABA is working on it, that means they've got some developmental STEPS for it, yes?  Are those steps in the VB-MAPP or ABLLS?  

 

Inhibition in Mother May I is WAY less challenging than not yanking a pen out of someone's hand.  Some kids will need help to get there.