Wednesday, June 17, 2009

Computerized COGNITIVE TRAINING: Preparing kids for school

Playing special computer games has been shown to help prepare kids for school. Psychologists at the University of Oregon designed games to train the network of brain areas involved in attention which undergoes important development between ages 3 and 7. The team of researchers was led by Dr. Michael Posner is a prominent scientist in the field of cognitive neuroscience.

At issue is "executive attention," or the ability to tune out distractions and pay attention only to useful information. Posner explains, “We human beings can regulate our thoughts, emotions, and actions to a greater degree than other primates. For example, we can choose to pass up an immediate reward for a larger, delayed reward. We can plan ahead, resist distractions, be goal-oriented. These human characteristics appear to depend upon what we often call ‘self-regulation’. All parents have seen this in their kids. Parents can see the remarkable transformation as their children develop the ability to regulate emotions and to persist with goals in the face of distractions.”

“It's important, particularly in child development, for the child's ability to regulate their thoughts and to control their emotions," says Posner. "This executive network, which tends to control the child's emotions, also allows them to continue to work on a particular task." There's great individual variation among healthy children and adults, and problems with this particular attention-paying neural network might be one of many factors involved in attention deficit hyperactivity disorder, or ADHD.

What is exciting these days is that progress in neuroimaging and in genetics make it possible to think about self-regulation in terms of specific brain-based networks.

Dr. Posner has been interested in how the attention system develops in infancy and early childhood.

One of his major findings is that there is not one single "attention", but three separate functions of attention with three separate underlying brain networks: alerting, orienting, and executive attention.

1) Alerting: helps us maintain an alert state. This involves the norepinephrine system, arising in the locus coeruleus and activating centers in the frontal and parietal lobes.

2) Orienting: focuses our senses on the information we want. It involves areas of the parietal lobe and frontal cortex, and seems to be particularly affected by the neuromodulator, acetylcholine.

3) Executive Attention: regulates a variety of networks, such as emotional responses and sensory information. It’s called the “executive” because it interacts with many other brain networks in regulating their activity. This is clearly correlated with academic performance. This network involves frontal structures such as the anterior singulate and lateral prefrontal cortex, as well as the basal ganglia.

Note that “executive attention” is different from “executive function”. Executive functions are goal-oriented. Executive attention is just the ability to manage attention towards those goals, towards planning. Both are clearly correlated. Executive attention is important for decision-making (how to accomplish an external goal) and with working memory (the temporary storage of information).

The development of executive attention can be easily observed both by questionnaire and cognitive tasks after about age 3–4, when parents can identify the ability of their children to regulate their emotions and control their behavior in accord with social demands.

Posner and his research team were interested in seeing whether, with a certain amount of training, they might be able to improve the efficiency of the network in children at the age when the network is developing.

The researchers studied groups of children age 4 to 6. Posner and his colleagues recruited 49 kids in the younger group and 24 in the older group. The children received intelligence and attention testing while most of them wore sensor nets on their heads to measure electrical signals on the brain's surface. Then, the children were randomly assigned to receive attention training or no training. Those in the training group were given increasingly difficult attention tasks.

The training was adapted from tasks that increase attention control in monkeys. "Training programs designed to teach monkeys to go into outer space and work on NASA experiments involved teaching those monkeys to resolve conflict between different thoughts. And that's a very important aspect of the executive attention network. So we decided we would adopt those training programs for children," Posner explains.

The children were asked to use a control device, like a game joystick, to move a cursor on a screen to the larger of two groups of objects. But a conflict was sometimes created by making the larger group have a lesser value, for example, the larger group was made up of lots of number 2's, while the smaller group consisted of number 7's. "So there's a conflict between going to the larger number of items and going to the larger digit," Posner says, "and the children are taught to resolve that conflict." In another task, children moved a cartoon cat across a computer screen using a joystick to keep the cat out of expanding muddy areas.

Using caps wired with electrodes the team recorded children’s brain waves at the beginning and at the end of the study. After training, all the children were again tested on intelligence and attention.

Researchers recorded in Proceedings of the National Academy of Sciences that the network became more efficient after just 5 training sessions. These findings have since been replicated in similar experiments by Spanish researchers.

After the training, Posner reported that 6-year-olds showed a pattern of activity in the anterior cingulate similar to that of adults. “Part of the network developed a more mature response, meaning it looked more like the adult subjects that we’ve also run in these experiments.” Posner said.

The researchers found that even this brief attention training improved one measure of IQ involving non-verbal reasoning. They also show clear post-training improvement on the Kaufman Brief Intelligence Test (KBIT) and in overall IQ, compared with controls. This suggests that they were not only able to train, but that they were able to get generalization--because the KBIT was different from anything they used in the training.

The brains of the 6-year-olds showed significant changes after the computer training compared with untrained playmates who watched videos. The researchers believe this shows that it is possible to train the executive attention network.

Brain regions activated in the 4-year-olds by attention training overlapped with those previously tied to IQ , Posner says. That neural intermingling toward the front of the brain could explain why average intelligence scores rose 6 points among 4-year-olds after attention training, compared with a 1-point increase for untrained 4-year-olds, he suggests. Trained 4-year-olds displayed a much narrower advantage on an attention test.

Among 6-year-olds, training yielded a slight IQ-score advantage but a marked gain in attention control, also called executive attention. During testing, trained kids in this group showed strong neural responses toward the back of the brain, whereas untrained kids displayed predominantly frontal-brain activity, perhaps reflecting conscious effort.

DNA testing examined a gene that influences transmission of the chemical messenger dopamine. Posner's findings indicated that 6-year-olds bearing one form of the gene displayed the poorest attention control before the training and the most improvement with training. In other words, children who were the most inattentive gained the most from the program. The gene variant had been previously linked to an outgoing temperament.

WATCH A VIDEO OF THE STUDY REPORT

For Posner, the findings hold exciting implications not just for helping children with attention-deficit problems, but for generally improving young children's education. He is now now calling on educators at conferences and in his book, "Educating the Human Brain," to consider teaching attention in preschool.

"We should think of this work not just as remediation but as a normal part of education," said Posner. "Attention plays a very important role in acquisition of high-level skills, and if attention is trainable, it becomes attractive for preschool preparation." Posner says that early childhood educators should pay attention to improving attention. Their research has important implications for schools, which are charged with educating an increasing number of students with attention disorders. If children entering school have better attention skills, then that allows them to absorb information better. That can increase their later attention and things could spiral. So, very small changes might turn out to be really quite important in the life of the child.

This type of cognitive training using computer games is in actual fact re-wiring the brain by building long range connections between different parts of the brain. For example, there is a type of neuron, named the Von Economo neuron, which is found only in the anterior cingulate and a related area of the anterior insula, very common in humans, less in other primates, and completely absent in most non-primates. These neurons have long axons, connecting to the anterior cingulate and anterior insula, which is part of the reason why we have Executive Attention. Neural networks like this are what enable specific human traits such as ‘effortful control’ which is a higher-order temperament factor consisting of attention, focus shifting, and inhibitory control - both for children and adults. A common example of this is how you often may make plans that you do not follow through with. Effortful control has been shown to correlate with the scores on executive attention at several ages during childhood, and imaging studies have linked it to brain areas involved in self-regulation. Good parenting has been shown to build good effortful control, so there are clear implications from this research.

Several training programs have been successful in improving attention in normal adults and in patients suffering from different pathologies. With normal adults, training with video games produced better performance on a range of visual attention tasks. There is no ceiling for abilities such as attention. The more training, even with normal people, the higher the results. Training has also led to specific improvements in executive attention in patients with specific brain injury.

With the global advent of brain-based education, Posner noted, such work has garnered increased support from national and international governments and nonprofit groups.

"These efforts are bringing together a platform where new findings about the brain--in literacy, numeracy and attention--can yield new interventions," says Posner. "We are on the threshold of important developments in education."

Dozens of schools nationwide are already incorporating some kind of attention training into their curriculum. And as this new arena of research helps overturn long-standing assumptions about the malleability of this essential human faculty, it offers intriguing possibilities for a world of overload.

"If you have good attentional control, you can do more than just pay attention to someone speaking at a lecture, you can control your cognitive processes, control your emotions, better articulate your actions," says Amir Raz, a cognitive neuroscientist at McGill University who is a leading attention researcher. "You can enjoy and gain an edge in life."

A parallel line of investigation is based on the close link between attention and memory. "Working memory" is the short-term cognitive storehouse that helps us recall a phone number or the image of a landscape; this type of memory is integral to executive attention. Tapping into this link, cognitive neuroscientist Torkel Klingberg of Sweden's Karolinska Institute devised computer software to improve executive attention by training working memory in teens and pre-adolescents with attention-deficit/hyperactivity disorder. Using a training program he calls "RoboMemo," Klingberg has helped children improve their working memory and complex reasoning skills, according to studies published in the Journal of the American Academy of Child and Adolescent Psychiatry, among other publications. This appears to pay off in attention as well. The children were also reported to be less impulsive and inattentive by their parents.

Christopher Lucas of New York University, one of the US researchers using Klingberg's software, used the RoboMemo training program to boost the visuospatial memory of a group of children, and found that as this type of working memory improved, they became more focused and compliant. Most encouraging is that this training was associated with an increase in positive behavior above and beyond medication and behavior treatments already in place.

Children differ in their attentional preferences, and in their capacity to regulate attention. Dr. Posner is currently working on a long-term study to train children at age 5 and then follow-up over the years, compared to a control group. They would like to track those kids over time and see what happens. For example, they will examine whether or not an early intervention might translate into a "snowball effect" of higher levels of cognitive and school performance. Posner's team is also studying attention training with preschoolers who have symptoms of attention-deficit hyperactivity disorder (ADHD). Some of their initial findings are reported here. Their experience in is that attention training can be adapted successfully for preschoolers, and has promising evidence as an intervention for children at-risk for or diagnosed with ADHD.

It is clear that executive attention and effortful control are critical for success in school. Will they one day be trained in all pre-schools? Dr Posner says “It sounds reasonable to believe so, to make sure all kids are ready to learn.” And that is what we believe too.

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References:

1. Training, maturation, and genetic influences on the development of executive attention. Rueda MR, Rothbart MK, McCandliss BD, Saccomanno L, Posner MI. Proc Natl Acad Sci USA. 2005 Oct 11;102(41):14931-6.

2. Computerized training of working memory in children with ADHD--a randomized, controlled trial. Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlström K, Gillberg CG, Forssberg H, Westerberg H. J Am Acad Child Adolesc Psychiatry. 2005 Feb;44(2):177-86.

3. A randomized controlled of two forms of computerized working memory training in ADHD. Christopher Lucas, M.D., M.P.H., Howard Abikoff, Ph.D., Eva Petkova, Ph.D., Weijin Gan, M.S., Solomon Sved, Lindsey Bruett, Brittany Eldridge, B.A. Meeting of the American Psychiatric Association, May 2008

4. “Distracted: The Erosion of Attention and the Coming Dark Age," by Maggie Jackson. June 2008

2. Posner Interviews:

Video: http://www.livescience.com/common/media/video/player.php?videoRef=attentiontraining

Photos: University of Oregon

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