Brain Plasticity_JT modified for JT only

Brain Plasticity and Non-Medication Interventions to treat AD/HD and Learning Disorders:

Brain Plasticity and Non-Medication Interventions to treat AD/HD and Learning Disorders Jay D. Tarnow, M.D. Diplomate of the American Board of Psychiatry and Neurology Certified in General Psychiatry and Child and Adolescent Psychiatry Clinical Associate Professor of Psychiatry-Baylor College of Medicine University of Texas Medical School at Houston

ADHD and Learning Disorders:

2 ADHD and Learning Disorders Medication is not enough Nonspecific

Lobes of the Brain:

3 Lobes of the Brain Frontal Lobe Located in front of the central sulcus. Concerned with reasoning, planning, parts of speech and movement(motor cortex), emotions, and problem-solving. Occipital Lobe Located at the back of the brain, behind the parietal lobe and temporal lobe. Concerned with many aspects of vision Parietal Lobe Located behind the central sulcus. Concerned with perception of stimuli related to touch, pressure, temperature and pain. Temporal Lobe Located below the lateral fissure. Concerned with perception and recognition of auditory stimuli (hearing) and memory (hippocampus). Neuroscience For Kids; http://faculty.washington.edu/chudler/lobe.html

Functional Divisions of the Cerebral Cortex:

4 Neuroscience For Kids; http://faculty.washington.edu/chudler/functional.html Functional Divisions of the Cerebral Cortex

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5 Brain Size Development

Brain Development:

6 Brain Development The brain adds comparatively few cells after birth. Instead, the existing neurons grow larger and more powerful, sprouting axons and dendrites and connecting with neighbors. Each neuron has formed as many as 10,000 connections, making a total of about a quadrillion (1,000,000,000,000,000) throughout the brain. Synapse formation slows after the toddler years, but continues throughout childhood and into adolescence, finally reaching adult levels when your child is anywhere from 15 to 18 years old.

Infancy to 4 Years:

7 Infancy to 4 Years Learning to Learn Learning Machine

Last Area to Develop:

8 Last Area to Develop Prefrontal cortex 18 years – 20 something.

The Synapse:

9 The Synapse Neuroscience For Kids; http://faculty.washington.edu/chudler/functional.html Neurons have specialized projections called dendrites and axons. Dendrites bring information to the cell body and axons take information away from the cell body.

The Synapse:

10 The Synapse Neuroscience For Kids; http://faculty.washington.edu/chudler/functional.html Axodendritic Synapse Axosomatic Synapse Axoaxonic Synapse

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The More Teaching Modalities Used the Better the Learning

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12 HOW THE BRAIN GETS SMARTER

Neurotransmitters:

13 http://www.niaaa.nih.gov/NR/rdonlyres/E545727D-C238-497C-8FAB-237E6B994092/0/synapse.gif Neurotransmitters Neurotransmitters

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14 NT Transporter (reuptake pump) Presynaptic Neuron Postsynaptic Neuron Neurotransmitter Transporter Neurotransmitter Output Storage Vesicle AMPH = NT = neurotransmitter; dopamine or norepinephrine AMPH = amphetamine MPH = methylphenidate Stimulants’ Proposed Mechanism of Action

Myelinization:

15 Myelinization

Myelinization:

16 Myelinization Process of myelination, which also began before birth, continues throughout childhood and helps the growing nerves communicate better.

Neuron Migration:

17 Neuron Migration Some neurons migrate by riding along extensions (radial glia) until they reach their final destinations. www.helpforheadaches.com

Pruning:

18 Pruning The neural networks that are used grow stronger; those that are not wither away, just as unused brain cells started dying in the last weeks before birth. This process is known as pruning. http://faculty.washington.edu/chudler/plast.html

Pruning:

19 Pruning Growth and pruning continue throughout our lives, but the relative balance of the processes changes. Until age 3, growth far outpaces pruning. From then until the age of 10, the formation of new connections is balanced by the elimination of unused ones. When puberty is reached, the balance finally shifts and the pruning of connections exceeds the formation of new ones. USE IT OR LOSE IT!!

“The principal activities of brains are making changes in themselves.”:

“The principal activities of brains are making changes in themselves.” --Marvin L. Minsky ( Society of the Mind , 1986)

Plasticity of Learning and Memory:

21 Plasticity of Learning and Memory At least two types of modifications that occur in the brain with learning: A change in the internal structure of the neurons, the most notable being in the area of synapses. An increase in the number of synapses between neurons.

Basics of Plasticity:

22 Basics of Plasticity In response to the right stimuli, neural connections can be rewired and refined, the brain’s gray matter can thicken, and new neurons can be produced. Scientists call this natural adaptive ability brain plasticity or neuroplasticity . Harnessing this ability can have dramatic – and sometime life changing effects.

Neuroplasticity:

23 Neuroplasticity Lifelong ability of the brain to reorganize neural pathways based on new experiences - learning.

The top images show the brain activity (lit-up areas) of a 10 year-old boy while he completes a task that requires the ability to identify the sounds of words. His reading level equaled that of an eight-year-old child. The bottom images show his brain activity while he completes the same task after receiving eight weeks of a type of special training. Following the intervention training, his reading level increased by three years and the images indicate that his brain activity changed as well. Researchers are conducting a very large, ongoing study to confirm this one example. :

24 The top images show the brain activity (lit-up areas) of a 10 year-old boy while he completes a task that requires the ability to identify the sounds of words. His reading level equaled that of an eight-year-old child. The bottom images show his brain activity while he completes the same task after receiving eight weeks of a type of special training. Following the intervention training, his reading level increased by three years and the images indicate that his brain activity changed as well. Researchers are conducting a very large, ongoing study to confirm this one example. www.sfn.org ; Society for Neuroscience, http://www.sfn.org/index.cfm?pagename=brainBriefings_brainPlasticityLanguageProcessingAndReading

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25 Models of the brain have changed from viewing plasticity as something occurring only at the early developmental stages to a view stressing a life-long plasticity of the brain.

Brain Plasticity:

26 Brain Plasticity The existence, and importance of brain plasticity are no longer in doubt. The brain is dynamic, and the life we lead leaves its mark in the complex circuitry of the brain.

Plasticity and Critical Periods:

27 Plasticity and Critical Periods This whole process of synaptic formation and subsequent pruning helps explain the plasticity that is central to understanding the brain. At birth, the brain develops partly because of genetic instructions ( NATURE ) and partly because of exposure to the outside world ( NURTURE ). Experiences help determine which synapse grow stronger and which are pruned.

Gene Expression:

28 Gene Expression

Plasticity and Critical Periods (cont.):

29 Plasticity and Critical Periods (cont.) The more that a particular brain network is activated, the stronger the signal becomes. At some point, the signal becomes so strong that it triggers a resiliency in the network , so that these connections cannot be pruned away.

Developing Pathways:

30 Developing Pathways Inside a child’s brain neurons are firing signals, selected synaptic connections are growing stronger, and myelin is coating the nerves to make them more efficient.

Norepinephrine Neurotransmission Relative to ADHD :

31 Locus Ceruleus Frontal Limbic Dampens noise Executive operations Increases inhibition Solanto. Stimulant Drugs and ADHD. Oxford; 2001. Norepinephrine Norepinephrine Neurotransmission Relative to ADHD

Dopamine Neurotransmission Relative to ADHD :

32 Enhances signal Improves attention Focus On-task behavior On-task cognition Solanto. Stimulant Drugs and ADHD. Oxford; 2001. Nigrostriatal Pathway Mesolimbic Pathway Substantia nigra Ventral tegmental area Mesocortical Pathway Dopamine Dopamine Neurotransmission Relative to ADHD

Facts About Neuroplasticity:

33 Facts About Neuroplasticity FACT 1: Neuroplasticity includes several different processes that take place throughout a lifetime. Neuroplasticity does not consist of a single type of morphological change, but rather includes several different processes that occur throughout an individual’s lifetime. Many types of brain cells are involved in neuroplasticity, including neurons, glia, and vascular cells. Neuroscience for Kids: faculty.washington.edu/chundler/plast.html

Facts About Neuroplasticity:

34 Facts About Neuroplasticity FACT 2: Neuroplasticity has a clear age-dependent determinant. Although plasticity occurs over an individual’s lifetime, different types of plasticity dominate during certain periods of one’s life and are less prevalent during other periods. Neuroscience for Kids: faculty.washington.edu/chundler/plast.html

Facts about Neuroplasticity:

35 Facts about Neuroplasticity FACT 3: Neuroplasticity occurs in the brain under two primary conditions: During normal brain development when the immature brain first begins to process sensory information through adulthood (developmental plasticity and plasticity of learning and memory). As an adaptive mechanism to compensate for lost function and/or to maximize remaining functions in the event of brain injury. Neuroscience for Kids: faculty.washington.edu/chundler/plast.html

Facts about Neuroplasticity:

36 Facts about Neuroplasticity FACT 4: The environment plays a key role in influencing plasticity. In addition to genetic factors, the brain is shaped by the characteristics of a person’s environment and by the actions of that same person. Neuroscience for Kids: faculty.washington.edu/chundler/plast.html

Plasticity:

37 Plasticity The blind use Occipital Cortex for sensation of touch or hearing and their memories. An Example:

PET Scan:

38 PET Scan Patients are injected with water in which the oxygen molecule bears radioactive “label” that emits a low level of radiation for about 15 or 20 minutes. Researchers then track brain activity by monitoring blood as it flows through the brain, delivering the labeled oxygen to brain cells. The highest level of radioactivity indicates the site of the greatest blood flow and therefore the most cellular activity at any given fraction of a second.

fMRI:

39 fMRI The oxygen-carrying red blood cells also alter those areas’ magnetic fields-and MRI machines are set up to measure fields. To use a series of MRI scans to monitor blood flow and oxygen consumption is called functional MRI (fMRI).

Example of use of scans in Learning Disabilities:

40 Example of use of scans in Learning Disabilities When a normal reader hears rapid sounds, the language-critical left frontal cortex lights up (left). When a dyslexic hears rapid sounds, no brain activity is recorded there and it remains dark. http://news-service.stanford.edu/news/2001/february14/dyslexia-214.html

Learning is a Complex Phenomenon:

41 Learning is a Complex Phenomenon

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42 Social Thinking System Higher Thinking System Motor System Sequential Ordering System Spatial Ordering System Language System Memory System Attention Control System The Neurodevelopmental System The Neurodevelopmental System Levine M.D., Mel. The Myth of Laziness . New York, N.Y:Simon & Schuster, Inc. 2004

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ADHD: Impact of Untreated & Under-Treated ADHD Health Care System 50%  in bike accidents 1 33%  in ER visits 2 2-4 x more motor vehicle crashes 3 1. DiScala et al., 1998. 2. Liebson et al., 2001. 3. NHTSA, 1997. 4-5. Barkley et al., 1993; 1996 6. Barkley, et al., 1990. 7. Mannuzza et al., 1997. 8. Biederman et al., 1997 . 9. Pomerleau et al., 1995. 10. Wilens et al., 1995. 11. Barkley, Fischer et al., 1991 12. Brown & Pacini, 1989. 13. Mash & Johnston, 1983. 14. Noe et al ., 1999. Health Care System 50%  in bike accidents 1 33%  in ER visits 2 2-4 x more motor vehicle crashes 3 Patient Family 3-5x  Parental Divorce or Separation 11,12 2-4 x  Sibling Fights 13 School & Occupation 46% Expelled 6 35% Drop Out 6 Lower Occupational Status 7 Society Substance Use Disorders: 2 X Risk 8 Earlier Onset 9 Less Likely to Quit in Adulthood 10 Employer  Parental Absenteeism 14 and Productivity 14

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44 DSM-IV Symptoms of Inattention Can’t organize Loses important items Easily distractible Forgetful in daily activities Careless Difficulty sustaining attention in activity Doesn’t listen No follow through Avoids/dislikes tasks requiring sustained mental effort Manifestations of the following symptoms must occur OFTEN* Inattention

Frequently Observed Conditions Associated with ADHD:

45 Frequently Observed Conditions Associated with ADHD Cognitive deficits Impaired adaptive functioning Motor development deficits Emotional dysregulation Impaired task performatnce Medical problems Barkley. Attention Deficit Hyperactivity Disorder. 1998:97-103;115-120;125.

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46 Psychobiology of ADHD: Brain Structures implicated THE CEO 1. Creates Working Memory - Organizers and structures - Remembers self in the future - Consequence Evaluation - Stops procrastination – long term goals 2. Time Estimator - Process details 3. Monitors Behavior - Self-talk - Observer THE GREAT INHIBITOR 1.Sustains attention stops distractions 2.Stops overfocus and being stuck 3. Error catcher- 4. Organizes how to behave REWARD CENTER 1. Response to bonding 2. Response to challenges 3. Seeks high stimulus AROUSAL CENTER 1. Deadlines 2. Actions 3. Tactics MODULATES EMOTION 1. Processes fear & excitement 2. Decreases the overwhelm 3. Responds to survival 4. Decreases noise Attention Network Adapted from Ratey JJ. A User’s Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain. New York, NY:Pantheon Books; 2001

“ADHD is a Disorder” Jay D. Tarnow, M.D.-1988:

47 “ADHD is a Disorder” Jay D. Tarnow, M.D.-1988 Delay of gratification Frustration tolerance Self-soothing Emotional regulation Management of impulses Inhibition of inappropriate behaviors Management of activity levels Connecting cause and effect Taking responsibility Capacity to be flexible Empathy and perspective taking Concentration and focus Ability to establish and maintain social relationships Self-monitoring Self-evaluation PIPE Self-Management Impairments in ADHD

What is Self-ManagementSM?:

48 What is Self-Management SM ? The ability to monitor and process internal and external information, Weigh that information to develop a good strategy, Execute a plan that fits the situation, Evaluate what worked and what did not, and Use that information to develop better plans and responses in the future.

Components of Self-Management:

Components of Self-Management Behavioral Inhibition 3 interrelated processes: Not initiating a response that has an immediate reward. Stopping an ongoing response, permitting a delay in the decision to respond or to continue responding. Not allowing other things to interfere with stopping the response.

Components of Self-Management :

Components of Self-Management Self-Control Actions taken to alter the chance of a subsequent response to an event. (Therefore, alters the probability of a later consequence.) Example: I eat a midmorning snack to avoid eating too much lunch.

Components of Self-Management :

Components of Self-Management Executive functioning Self-directed actions mental activities that are used to self-regulate

Components of Self-Management:

Components of Self-Management Self-management involves the culmination of behavioral inhibition , self-control , and executive functioning . Control one’s own conscious mind Direct one’s thoughts and actions without yielding immediately to the “pull” of the internal or external environment Use one’s mental world to control and regulate thoughts, feelings, actions, and relationships

“Executive Functions”:

53 “Executive Functions” Wide range of central control processes Connect, prioritize, and integrate cognitive functions moment-by-moment Integrate stored memories with current information Guide current thoughts and actions Analogous to the conductor of a symphony orchestra

Executive Functions = Self Management:

54 Executive Functions = Self Management Ability to observe oneself Contemplate our choices & actions Develop goals & objectives Devise plans of action to attain Organize & prioritize Flexibility to try something new if attempts fail Focus, shift, sustain attention Sustain alertness, effort, & processing speed

Executive Functions = Self Management :

55 Executive Functions = Self Management Manage frustration, modulate emotion, self soothe Delay gratification Use working memory access recall Connecting cause & effect Take responsibility for one’s actions Monitor & regulate action Inhibit inappropriate behavior Regulate social relationships

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Executive Functions Impaired in ADHD Executive Functions Organizing, prioritizing, & activating work 1. Activation Focusing, sustaining focus, & shifting focus to tasks 2. Focus Regulating alertness, sustaining effort, & processing speed 3. Effort Managing frustration & modulating emotions 4. Emotion Using working memory & accessing recall 5. Memory Monitoring & self-regulating action 6. Action Brown TE. Manual for Brown Attention Deficit Disorder Scales , San Antonio, TX: The Psychological Corp.; 2001.

Self-Management Competencies for Young Children:

Self-Management Competencies for Young Children 1. Frustration Tolerance 2. Delay of Gratification 3. Management of Impulses 4. Management of Activity Levels 5. Taking Responsibility 6. Connecting Cause & Effect 7. Capacity to be flexible 8. Concentration & Information Tracking 9. Empathy & Perspective Taking

Self-Management Competencies for Adolescents:

Self-Management Competencies for Adolescents 9. Ability to Overcome Homesickness 8. Moral Values 3. Capability to Set Goals and Meet Them 6. Ability to Handle Romantic Involvements 5. Money Management Skills 4. Emotional Security 2. Intellectual & Academic Skills 7. Social Skills Needed for Living in New Setting 1. Problem-Solving Skills

ADHD medications do make the brain ready to learn:

ADHD medications do make the brain ready to learn

ADHD medications do not cure ADHD or correct Learning Disorders:

ADHD medications do not cure ADHD or correct Learning Disorders When taking medication it does help stimulate more connections temporarily It is a splint to support learning

Stimulants’ Proposed Mechanism of Action:

61 NT Transporter (reuptake pump) Presynaptic Neuron Postsynaptic Neuron Neurotransmitter Transporter Neurotransmitter Output Storage Vesicle AMPH = NT = neurotransmitter; dopamine or norepinephrine AMPH = amphetamine MPH = methylphenidate Stimulants’ Proposed Mechanism of Action

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ADHD has high potential for addiction because of the faulty adrenergic reward system:

65 ADHD has high potential for addiction because of the faulty adrenergic reward system

The Brain’s Reward System:

66 The Brain’s Reward System Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine. The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli. Stressors or something associated with substance use can trip the mental machinery of relapse.

SUD Severity Associated with ADHD:

67 SUD Severity Associated with ADHD Earlier onset of SUD More problematic substance abuse A reduced likelihood of going into remission if dependence develops If remission achieved, longer time to reach remission More treatment exposure, yet do less well in treatment Higher rates of other psychiatric comorbidities (e.g. conduct/antisocial disorders)

Slide 68:

68 Relationship Between ADHD and SUD Over the Lifespan ADHD treatment protects against later SUD Wilens 91

Slide 69:

69 Learning Disorders (CAPD,LD,ADD, Dyslexia) FIGURE 3.1. Venn diagram depicting the overlap between learning disabilities and ADHD ADHD LD 20-40%

Academic Impairment:

70 Very well documented Failure to perform academically is the single most common reason for referral of children and adolescents Children with ADHD Perform poorly on achievement tests and failed grades/courses significantly more often than children without ADHD Complete 3 fewer years of education than matched controls Are more likely to not graduate from high school Academic impairment more profound when learning disabilities are present ADHD & LD lead to higher incidence of Psychiatric Disorder Weiss and Hechtman. Hyperactive Children Grown Up. 2 nd ed. New York: Guildford Press; 1993. Mannuzza and Klein. The Economics of Neuroscience . April 2001:47-53. Academic Impairment

High Coincidence of Sociobehavioral and Communicative Disorders:

71 High Coincidence of Sociobehavioral and Communicative Disorders Half of children diagnosed with Communication disorders have socioemotional and behavioral problems. Prizant & Meyer (1993) Two thirds of children referred to psychiatric inpatient hospital failed speech and language screening. Prizant, et al., (1990)

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72 High coincidence of Sociobehavioral and Communicative Disorders Sixty-five percent of children in psychiatric outpatient clinics failed speech and language screening. One third of Conduct Disorders had concomitant speech and language difficulties. Two thirds of ADHD/ADD children have language disabilities. (Gidden 1991)

Language is essential for healthy::

73 Language is essential for healthy: Psychological Development Social Development Cognitive Development Learning Development Self-Management Development

Attention and Communication are essential for learning:

74 Attention and Communication are essential for learning

Reading:

75 Reading

Memory:

76 Memory Memory is not in fact a single function but a collection of mental abilities that depend on different systems within the brain.

Types of Memory:

77 Types of Memory Declarative memory- conscious recall of facts and events Nondeclarative memory- skills, habits, and reactions we remember without conscious effort

Emotional Memory:

78 Emotional Memory This kind of memory depends on the amygdala. The amygdala also modulates declarative and nondeclarative memory. Thus we remember arousing (declarative) events better than boring ones.

Sensory Memory:

79 Sensory Memory When information enters our eyes, ears, or other sensory channels, the nervous system creates a very brief but thorough record of all those stimuli. This sensory memory can hold a great deal of information, but only for a short period.

Slide 80:

80 Working memory is The ability to keep information in your mind for a short period of time (seconds) and be able to use this information in your thinking .

Short-Term Memory (Working Memory):

81 Short-Term Memory (Working Memory) Short-term memory is processed by the data being processed by different parts of the brain depending on the sensory data. For example: Images and patterns are stored temporarily. “Visuospatial-Scratch Pad” Speech based information travels the phonological loop .

Slide 82:

82 Input Phonological Loop Attentional Control Visuospatial Scratch-pad Central executive Diagram of working memory

Slide 83:

83 Short-term memory involves temporary changes in neurons’ electrical activity and the chemicals that they exchange through their synapses.

Working Memory:

84 Working Memory Prefrontal and parietal regions are important for working memory and dopamine is a central neurotransmitter.

Impairments in Working Memory:

85 Impairments in Working Memory Impairments in working memory are found in several clinical disorders in which these systems are implicated, such as AD/HD, Learning Disabilities, after stroke, traumatic brain injury and the aging brain.

Working Memory:

86 Working Memory Working memory is plastic. Like a muscle, it can be improved through exercise Working memory is definitively linked to attention control

Slide 87:

87 Working memory is essential for: Controlling attention Reading comprehension Mathematical reasoning Planning and organizing activities Keeping instructions in mind Resisting distraction Problem solving and fluid intelligence © 2007 Cogmed

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88 http://images.google.com/imgres?imgurl=http://thebrain.mcgill.ca/flash/i/i_07/i_07_p/i_07_p_tra/i_07_p_tra_2a%2520copy.jpg&imgrefurl=http://thebrain.mcgill.ca/flash/i/i_07/i_07_p/i_07_p_tra/i_07_p_tra.html&h=360&w=364&sz=40&hl=en&start=4&um=1&tbnid=_oG9WixnEr18AM:&tbnh=120&tbnw=121&prev=/images%3Fq%3Dshort%2Bterm%2Bmemory%26um%3D1%26hl%3Den%26rlz%3D1T4DMUS_enUS221US228%26sa%3DN

Long-Term Memory:

89 Long-Term Memory Second important phase of storing new information is consolidation: organizing the new material alongside what the mind has already remembered.

Long-Term Memory:

90 Long-Term Memory To store information in long-term memory, the brain must make more permanent changes, which take two forms: Nerve cells can extend their axons, thus allowing more connections to other cells. Cells can increase their ability to release chemical neurotransmitters through their synapses, thus increasing the power of each connection.

In everyday life, we draw on all these memory systems in tandem to learn:

91 In everyday life, we draw on all these memory systems in tandem to learn

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92 Signs of a poor working memory An inability to maintain attention Distractibility An inability to start projects or follow them through to completion Problems remembering instructions A habit of interrupting or not waiting for one’s turn Difficulties getting organized Learning difficulties © 2007 Cogmed

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93 DSM-IV Symptoms of Inattention Can’t organize Loses important items Easily distractible Forgetful in daily activities Careless Difficulty sustaining attention in activity Doesn’t listen No follow through Avoids/dislikes tasks requiring sustained mental effort Manifestations of the following symptoms must occur OFTEN* Inattention

Slide 94:

94 The working memory gap © 2007 Cogmed Test performance Visuospatial Working Memory Capacity

A deficit in working memory:

95 A deficit in working memory Can lead to poor performance in math, science, reading, test taking, and complex problem solving when compared to their peers Children with attention deficits often have working memory deficits It is possible to improve working memory with sustainable results

Working memory and Academics:

96 Working memory and Academics Age Working memory is crucial for… Indicators that a working memory needs exercise Pre-School Learning the alphabet Completing a puzzle independently Unwillingness to learn Elementary school Understanding textual content (reading comprehension) Mental arithmetic Inability to understand what is read Problems memorizing the multiplication table Middle school Completing homework independently Complex math problems, especially word problems Can’t complete homework without parental supervision and direction Inability to grasp/break down word problems High School Writing essays Constantly procrastinates; panics the night before an exam Doesn’t listen or participate during a group project Difficulty remaining attentive during lectures

Working Memory and Academics:

97 Age Working memory is crucial for… Indicators that a working memory needs exercise College Staying focused in a conversation, grasping the core of the conversation Participation in group projects Changes subjects frequently, adds irrelevant comments Constantly procrastinates; panics the night before an exam Doesn’t listen or participate during a group project Adults Handling conflicts within the family Often looses temper with children and spouse Seniors Carrying out planned activities Organizing materials and activities Managing financial transactions Forgetfulness Distractibility Difficulty staying on topic in a conversation Misplacing items Working Memory and Academics

Working Memory:

98 Working Memory WM Capacity, as measured for example by the visuo-spatial span-board task, develops during childhood and adulthood to reach a maximum at about 25 years of age. This capacity then gradually declines during the aging process. Capacity

Working Memory and Professional Life:

99 Working Memory and Professional Life Professionals use working memory for… Indicators that a working memory needs exercise Getting to work on time Meeting deadlines at work Multi-tasking and prioritizing Working effectively in pressure situations Remembering important names and phone numbers Interaction with co-workers Writing emails, memos or summaries Frequently late to work Underestimates time required to complete a task Problems breaking a project down into manageable steps ore dealing with more than one task at a time Can’t concentrate under pressure; prone to panicking Can’t remember clients’ names or numbers after meeting them or hanging up the phone Difficulty creating neat and coherent emails, memos, or summaries

Working Memory:

100 Working Memory Working memory can be strengthened Dr. Torkel Klingberg proved it to be a plastic function of the brain, able to be strengthened through rigorous training. (Klinberg et al., 2002)

Working memory is plastic. Like a muscle, it can be improved through exercise.:

101 Working memory is plastic. Like a muscle, it can be improved through exercise. Increased prefrontal and parietal activity after training of working memory

Endless Possibilities :

102 Endless Possibilities This discovery has sparked a revolution in brain health and science. The promise includes a broad range of exciting applications, from enhancing cognitive performance to reversing serious disorders. http://merzenich.positscience.com/about-brain-plasticity

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ADHD Self-Management Resources Online:

104 ADHD Self-Management Resources Online Information about ADD/ADHD for patients, families and professionals Clinician-authored articles about a range of ADD/ADHD-related topics More information about working memory and non-medication interventions Recommended reading, video Q&A, and helpful links. Please visit ADHDSelfManagement.com for: Sponsored by the Tarnow Center for Self-Management, Jay D. Tarnow, M.D.

With our better understanding of the continuing development of the brain throughout life, we are able to create programs that address the underlying health of the brain.:

With our better understanding of the continuing development of the brain throughout life, we are able to create programs that address the underlying health of the brain.

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To be successful, you have to practice success

Certain Conditions Encourage Learning:

107 Certain Conditions Encourage Learning The neuroscientist have demonstrated that new pathways can be established when interventions which provide intensive stimulation to the brain over a specific amount of time while the student is: Actively involved in the process Where a response to the stimulation is required When immediate feedback and reward are provided

Slide 108:

Research has shown that engaging the brain’s plasticity to drive beneficial changes requires exact stimuli delivered in the appropriate sequence with precise timing. The training must be intensive, repetitive, and progressively challenging. http://merzenich.positscience.com/about-brain-plasticity

What Do Brain Science Studies Tell Us About the Principles of Learning:

109 What Do Brain Science Studies Tell Us About the Principles of Learning Brain remodeling only occurs when the child is closely attending and only when the child is motivated to listen or observe carefully to them. They show that brain remodeling to overcome a problem that has has been embedded in the brain through several to many prior years of practice can only be overcome by the implementation of a heavy schedule of practice trials.

Slide 110:

110 Training must be progressive and adaptive (I.e., get gradually harder as progress is made). The subject must always get most answers right, and they must start at a training level at which that is achieved. Every child has a different starting point, and every child will proceed in training at a different pace. What Do Brain Science Studies Tell Us About the Principles of Learning

Timing is Everything:

Timing is Everything

Neuroscience principles :

112 Neuroscience principles Frequency and intensity Adaptivity Simultaneous development Timely motivation

How do Fast ForWord Products Improve Cognitive Skills?:

114 How do Fast ForWord Products Improve Cognitive Skills? F requency and intensity- brain plasticity research demonstrates that completing a set of learning tasks in a frequent, intense timeframe accelerates learning. A daptivity- interactive exercises automatically adapt to individual skill levels and responses, adjusting the learner’s content exposure and targeting correct responses approximately 80% of the time, which maintains challenge and motivates success.

How do Fast ForWord Products Improve Cognitive Skills? FAST:

115 How do Fast ForWord Products Improve Cognitive Skills? FAST S imultaneous development- each exercise focuses on a specific set of reading or language tasks and simultaneously develops underlying cognitive processes such as memory, attention, and processing. T imely motivation- for the brain to learn, students must be active, attentive and engaged. Rewards are provided on the first attempt only, a proven neuroscience motivation technique.

Fast ForWord Training Software:

116 Fast ForWord Training Software

Learning MAPs:

117 Learning MAPs Fast ForWord products improve essential cognitive skills-Learning Maps TM Reading and learning require a variety of cognitive skills that must function effectively in unison. Fast ForWord products develop Learning MAPs skills, critically important prerequisites for successful reading. When Learning MAPs are stronger, students are able to benefit from reading instruction.

What are Learning MAPs? :

118 What are Learning MAPs? M emory – hold information and ideas short and long-term: essential for word recognition, comprehension of complex sentences, and remembering instructions. A ttention-focus on tasks and ignore distractions P rocessing – see and distinguish images and sounds quickly enough to discriminate their differences; a prerequisite for phonemic awareness and reading. S equencing- cognitive skills that relies on memory, attention, and processing, and is essential for phonics, word fluency, reading and oral comprehension

Fast ForWord Results shown on fMRI:

Fast ForWord Results shown on fMRI

Improved Reading Skills:

120 Improved Reading Skills Grade Equivalent Sixteen to twenty-one year olds attending an alternative high school in a large urban school district improved two and one-half grade levels in reading performance after just 6 weeks of using Fast ForWord software with recommended protocols. Details for these results and additional studies can be found at www.scientificlearning.com/results

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121 Improved Language Skills Standard Score (Mean=100) The Fast ForWord family of products has helped students who are receiving special education services attain higher levels of academic achievement. In this group, students eligible for special education services made significant improvements in their critical reading-related language skills. Details for these results and additional studies can be found at www.scientificlearning.com/results

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122 Secondary Language Learning Standard Score (Mean= 50) Students identified as having limited English proficiency had dramatic results from the use of Fast ForWord with a significant positive impact on their neuro-cognitive skills that help academically struggling students with limited English proficiency Details for these results and additional studies can be found at www.scientificlearning.com/results

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123 At-Risk Learners Standard Score (Mean= 50) This research was part of a multi-site randomized comparison trial that took place in nine school districts in five US states with more than 500 students. Students were deemed by their teachers as “at-risk” for academic failure and were randomly assigned to an experimental group. The students who use Fast ForWord software made significantly greater improvements than the comparison group. Details for these results and additional studies can be found at www.scientificlearning.com/results

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124

Cogmed Working Memory Training:

125 Cogmed Working Memory Training Cogmed Working Memory Training is a proven, software-based intervention specifically designed to help children with serious attention deficts. Working Memory Training improves the ability to concentrate and the ability to control impulse behavior.

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126 Cogmed training software

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127 Outcome Measure Results Klingberg et al. (2005) JAACAP At follow up, the performance in the treatment group was about as high as, or higher than, at post-intervention Control Treat Visuospatial

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128 Long-lasting effects A one-year follow-up analysis of users confirms that results are maintained Of the 80% who have benefited after training : Data on file, Cogmed (2007) © 2007 Cogmed

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129 Rating scores of ADHD symptoms (DSM-IV) Klingberg et al. (2005) JAACAP

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130 Listening skills/attention span Class participation Attitude Confidence Self-esteem Motivation Productive use of time Anxiety and stress levels Positive and appropriate behavior Students Become Better Learners  Cogmed2007

Revolution in Learning and Developmental Rehabilitation:

Revolution in Learning and Developmental Rehabilitation

Science Overview:

Science Overview “Motor Planning and sequencing is a critical component of the deficit in a variety of developmental and learning disorders.” The Motor Planning Processes of Organizing and Sequencing are a core function of the brain - Stanley I. Greenspan, M.D.

Who Can Benefit from Interactive Metronome?:

133 Who Can Benefit from Interactive Metronome? Rehabilitation Loss of Motor Control Loss of Speech/Cognition Loss of Balance and Gait Performance Enhanced Coordination Improved Focus and Attention Improved Academic Performance Neuro-Scholastic ADD/ADHD Sensory Integration Language Processing Motor Control and Coordination PLANNING SEQUENCING TIMING

InteractiveMetronome:

134 InteractiveMetronome

Benefits of IM:

135 Benefits of IM Non-invasive Non-pharmaceutical (not exclusive of Rx) Complements existing therapy Short-term Measurable outcomes Functional cross-over

Developmental Therapy Overview:

136 Developmental Therapy Overview IM has undergone scientific trials and has been shown to improve: Attention and Concentration Motor Control and Coordination Cognitive Processing Reading and Math Fluency Control of Aggression/Impulsivity

Results from Early Clinical Trials:

137 Results from Early Clinical Trials Results from a Pilot fMRI (Brain Scan) study show IM Directly Activates Multiple Parts of the “Neuronetwork” CINGULATE GYRUS BASAL GANGLIA MEDIAL BRAINSTEM Allows Shifting of Attention Cognitive Flexibility Integrates Thought and Movement Neuro-Motor Pipeline

Conclusion:

138 Conclusion Using these new pathways and practicing the new skills result in permanent changes in the brain. The pathway must then be used in various settings (educational therapy, school, social settings) for the skills to generalize and become new “habits”.

Conclusion:

139 Conclusion Working in a organized manner The more assistance and condition we provide this most important muscle the better off the student will be when he or she is actually required to achieve formal learning in the classroom.

Conclusion:

140 Conclusion These programs when used in a total therapeutic intervention program that includes education, language and/or psychotherapeutic intervention, are proving to be very effective. These programs provide the “brain foundation” that promotes success in much the same way as the foundation to a house must be constructed before the rest of the structure can be securely built.