‘Emily’ (not her real name) is in Grade 3: her teacher is worried because she daydreams, has trouble following multi-step directions and is falling behind her peers in class. Emily is a bright and caring girl who is no trouble in class, is amazing at art and loves looking after her friends. However, she is starting to feel bad about her difficulty remembering what she is taught and some of her classmates have started teasing her about this- she comes to her teacher in tears, after a spelling test, saying she feels ‘dumb’. Fast forward a few months... the educational psychologist has seen her and the report comes back with “normal IQ but very low working memory”. At the next PT meeting, her parents bring out a glossy brochure about Brain Training. Could this be the answer?
As a developmental paediatrician, I frequently see children like ‘Emily’, who are referred via their family doctors for evaluation of learning difficulties or school refusal, often with the additional questions of whether they could have ADHD or whether they could have a mood disorder, such as Anxiety or Depression. These referrals are often driven by their parents or teachers, and a cognitive assessment has sometimes already been carried out, and has concluded that the child doesn’t have an Intellectual Disability and therefore isn’t eligible for PSD funding.
As a researcher, I recently had the opportunity to investigate Cogmed, one of the best known computerised ‘Brain training’ programs on the market.(Roberts et al., 2016) Our team used a research methodology called a Randomised Controlled Trial, and we recruited families who had children with low working memory in Grade 1 (452 children from 44 State, Catholic and Independent schools in Melbourne): these children were randomly allocated to receive either the 5 week Cogmed training program in school (the intervention), or to receive ‘usual teaching’ (the control). We checked in with the children, their parents and teachers after 6, 12 and then 24 months. At 6 months, we were cautiously optimistic: the training group, compared with the ‘control’ group, had improved scores on 2 out of the 4 memory measures. This replicated what Cogmed’s parent company, Pearson, publishes on its website (http://www.cogmed.com.au/research). However, at 12 and 24 months, the intervention group looked no different to the control group in terms of their academic outcomes or on parent and teacher reports of behaviour, attention and daily function.
What do we conclude from this? The results are quite specific: our study shows no evidence that Cogmed brain training, for Grade 1 children who were identified on screening as having low working memory, makes any difference to academic or behavioural outcomes in Grade 2 or Grade 3. Because we designed the study to see if Cogmed could prevent problems in at-risk children, we are not able to extrapolate our results, for example, to older children or children with ADHD or learning disabilities. What if the training was provided for longer, or with the top-up session every few months or alongside a literacy or numeracy intervention? Our results do not allow us to provide an evidence-based answer to these questions.
Fortunately, many other cognitive scientists around the world are trying to pull together the current evidence to guide us. In 2016, a group of experts from the USA and UK published a comprehensive review, titled ‘Do “Brain-Training” Programs Work?’(Simons et al., 2016) They carried out this work in response to 2 previous open letters published in 2014 by different groups of experts that had different conclusions. The first concluded that ‘we object to the claim that brain games offer a scientifically grounded avenue to reduce or reverse cognitive decline’ (http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/) but the other, in response, argued back that ‘certain cognitive training regimens can significantly improve cognitive function, including in ways that generalize to everyday life (http://www.cognitivetrainingdata.org/the-controversy-does-brain-training-work/response-letter/). The authors of the 2016 paper, therefore, dug deep into the available scientific literature and tried to explain how two groups of scientists could hold such diametrically opposed views.
For the interested reader, this paper is worth examining in detail. There are, however, a few important take home messages. First, that that there is good evidence that brain training interventions improve performance on trained tasks (that is, if you practice a training game over and over, you get better at playing this game). Second, there is less evidence that this training improves function on non-trained but closely related tasks (this is called ‘near-transfer’, and we demonstrated this with our 6 month memory tests).(Roberts et al., 2016) Finally, there is very little evidence that brain training improves function on distantly related tasks such as everyday cognitive or learning skills (this is called ‘far-transfer’ and matches what we found at 12 and 24 months, when the kids in our study had moved to Grade 2 and 3).(Roberts et al., 2016). They also give some very helpful recommendations for scientists and funding bodies about designing future studies, and also very useful recommendations for consumers, including being sceptical of a ‘quick-fix’ if your long-term goal is to improve learning skills, and to remember to think of the opportunity costs of doing a brain-training intervention (what else you may have spent your time or money doing).(Simons et al., 2016)
So, where does this leave us when we are trying to help kids with working memory problems, especially if they are already falling behind, or are losing confidence in their own abilities? One of the authors of the review paper and a co-investigator on our trial, Professor Susan Gathercole form Cambridge University, has published very helpful information about how to modify the classroom environment to try to help these children, who frequently become overwhelmed with too much information input. This booklet can be downloaded here: ww.mrc-cbu.cam.ac.uk/wp-content/uploads/2013/01/WM-classroom-guide.pdf, and contains helpful tips that can be written into the child’s Individual Learning Plan and also discussed with his or her family for use at home.
As a paediatrician, once I have excluded contributing medical causes and associated problems such as mood or attention disorders, this is the advice that I give families: work with your teachers to develop a full understanding of your child’s profile of strengths and vulnerabilities, and then develop a plan together to help the student to achieve their best despite these vulnerabilities. If working memory difficulties are the main driver for the learning problems, we have to remember that the student is likely to be lost and overwhelmed in a busy classroom environment, so we need to develop a plan to present information in a way that doesn’t overwhelm their working memory capacity. There are, unfortunately, no quick fixes, but if we, as caring and nurturing mentors, can keep the student motivated and engaged and interested, they are likely to find their path in life.
Roberts, G., Quach, J., Spencer-Smith, M., Anderson, P. J., Gathercole, S., Gold, L., Wake, M. (2016). Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory: A Randomized Clinical Trial. JAMA Pediatr, 170(5), e154568. doi: 10.1001/jamapediatrics.2015.4568
Simons, D. J., Boot, W. R., Charness, N., Gathercole, S. E., Chabris, C. F., Hambrick, D. Z., & Stine-Morrow, E. A. (2016). Do “Brain-Training” Programs Work? Psychol Sci Public Interest, 17(3), 103-186. doi: 10.1177/1529100616661983
Gehan Roberts is a developmental-behavioural Paediatrician and holds appointments with The Royal Children’s Hospital’s Centre for Community Child Health, the Murdoch Childrens Research Institute, and is an Associate Professor at the University of Melbourne. He has a Masters in Public Health from Harvard University and a PhD in the field of child development from the University of Melbourne. He coordinates the Victorian Training Program in Community Child Health, is an Associate Director (Clinical Services) at the Centre for Community Child Health, and is engaged in research, clinical supervision and teaching. In 2016, he was elected President of the Neurodevelopmental and Behavioural Paediatric Society of Australasia, the peak body for Australasian doctors who care for children with developmental disorders.