Sunday, January 27, 2008



SharpBrains 2007

Today we interview Dr. Arthur Lavin, Associate Clinical Professor of Pediatrics at Case Western School of Medicine, pediatrician in private practice, and one of the first providers of Cogmed Working Memory Training in the US (the program whose research we discussed with Dr. Torkel Klingberg and Dr. Bradley Gibson). Dr. Lavin has a long standing interest in technology-as evidenced by Microsoft’s recognition of his paperless office- and in brain research and applications-he trained with esteemed Mel Levine from All Kinds of Minds.

• Schools today are not yet in a position to effectively help kids with cognitive issues deal with increasing cognitive demands.
• Working Memory is a cognitive skill fundamental to planning, sequencing, and executing school-related work.
• Working Memory can be trained, as evidenced by Dr. Lavin’s work, based on Cogmed Working Memory Training, with kids who have attention deficits.

Context on cognitive fitness and schools

AF (Alvaro Fernandez): Dr. Lavin, thanks for being with us. It is not very common for a pediatrician to have such an active interest in brain research and cognitive fitness. Can you explain the source of your interest?

AL (Arthur Lavin): Throughout my life I have been fascinated by how the mind works. Both from the research point of view and the practical one: how can scientists’ increasing knowledge improve kids’ lives? We now live in an truly exciting era in which solid scientific progress in neuroscience is at last creating opportunities to improve people’s actual cognitive function. The progress Cogmed has achieved in creating a program that can make great differences in the lives of children with attention deficits is one of the most exciting recent developments. My colleague Ms. Susan Glaser and I recently published two books: Who’s Boss: Moving Families from Conflict to Collaboration (Collaboration Press, 2006) and Baby & Toddler Sleep Solutions for Dummies (Wiley, 2007), so I not only see myself as a pediatrician but also an educator. I see parents in real need of guidance and support. They usually are both very skeptical, since they have been promised too many things too many times by “experts”, yet open-minded to ideas with good foundations. Many professionals have only the skeptical frame, since they were educated when scientists still believed the brain was pretty rigid and “untrainable”. We need much more brain science-based professional development, and appreciate the great work SharpBrains is doing.

AF: Let’s talk about that “trainability” and schools. Most people still think of “intelligence” as fixed. Now, I recently read a report on how KIPP schools emphasize the training on some basic skills, such as shared attention, as a needed foundation for good academic performance. So, even if limited in scope, it seems some schools are starting to understand their role in cognitive development. In your experience, are schools fulfilling their roles as “brain gyms”, places where young minds get shaped and ready for life?

AL: Good question. I have been a pediatrician working with schools in the Cleveland area since 1985, seen all kinds of diseases. For example, I have witnessed the growing incidence of autism spectrum disorders, such as autism and Asperger’s. I have also observed how school work has increasingly become more cognitively demanding, starting from kindergarden. There is too much pressure today, and a growing number of problems, yet I don’t see that schools are applying the best knowledge of how minds work. Just as doctors offices are centers of applied medical science, taking the latest advances in medical research and applying them to the medical care of people, schools should be the best place for applied neuroscience, taking the latest advances in cognitive research and applying it to the job of educating minds. Yet, they aren’t, and I can’t blame them , given the wide variety of pressures they work under, and the large change in perspective becoming institutes of applied neuroscience would take.

A cognitive gap?

AF: Some readers may be skeptical of the claim that school work is more demanding today than, say, 20 years ago. They may say kids are simply becoming “lazy”. What do you say to that?

AL: I have never met a lazy kid. All people want to succeed, in life if not in school. Most children who struggle at school struggle mightily to get adequate grades. It is true that some are more resilient that others-if they fail, they will try 10 times harder. The ones that are labeled as “lazy” are typically ashamed of their lack of capacity to deal with demands, and resort to an evasive strategy, they try to avoid the whole situation, run away.

AF: You mention a “lack of capacity to deal with demands”. Is that gap growing? The equation has 2 components: capacity and demands. In terms of capacity, let me mention that recently, the French Education Ministry just introduced mental arithmetic as part of the curriculum. I remember, as a kid, spending many hours in the math class where the teacher would require us to perform a progressively complex sequence of mental calculations-which is good training for skills such as working memory. Memory traininIn terms of demands, I can see how complex homework assignments are these days even in 3-4rd grade. Kids need to plan and prepare a whole matrix of tasks that require good organizational work to complete. They need to sequence what they do today, tomorrow, the day after. The major difficulty, for which such young brains may not be fully ready, is to deal with an overwhelming amount of information and demands, and execute.

AL: Great point. For example, years ago we had to memorize long texts, which, no matter what the content was, was a great way to train and build our attention span, working memory, and to devise strategies to learn. Today, there are less opportunities for such training.

Working Memory and Attention Deficits

AF: That seems to imply a higher need for good executive functions than years ago. A kid needs to have good working memory to retain, prioritize and sequence much information into actionable plans, and then execute them, as I had the fortune to discuss with Mark Katz some months ago. From my previous interviews with Dr. Klingberg and Dr. Gibson, we know that a common problem with many kids with diagnosed attention deficits is, indeed, working memory (the ability to hold in mind and manipulate several units of information). Can you explain what you see in your work with schools?

AL: I am afraid that many schools are too quick to diagnose ADD/ ADHD and consider drugs as the only potential intervention. The label itself can be misleading and counterproductive. School psychologists have wonderful expertise in evaluating subject-related problems and describing attentional deficit symptomatology, but are not trained or asked to complete neuropsychological profiles of a child’s cognitive functions. Up to a point, many kids with attention problems would benefit from educational, not medical, interventions to improve cognitive functions such as working memory. I am seeing it first hand, having used Cogmed Working Memory Training (also called RoboMemo) with 15 pre-screened kids: 80% of them presented a substantive improvement. With 50%, the results we have seen have been dramatic.

AF: Please give us some examples, so our readers can better understand what working memory is and its role in academic performance and daily life.

AL: Let me give you 3 vignettes, all 3 with diagnosed attention deficits, who showed clear benefit not only on cognitive functioning but also on AD/HD rating scales.
Patient 1: 11-year-old boy, very impulsive, even on medication. Doesn’t do homework, constantly forgets chores. After the 5-week program, he is able to sit down and listen instructions, engaging in fewer arguments with his parents. He can do better mental math- for the first time in his life able to do so without using his fingers. He finds that following school and doing homework is easier, grades have improved dramatically.
Patient 2: 16-year-old girl with ADD. She has trouble executing homework, often telling parents she had done it when she really hadn’t. Her parents thought she liked to lie. Yet, when I talk to her, she is clearly more ashamed than dishonest. The working memory training program helps her develop a much improved perception of time. For example, she starts to manage her shower time better, being aware of when 5 minutes have passed-instead of spending 30 minutes in the shower, as before. Much improved school work, lying at home has dropped dramatically.

Patient 3: 19-year-old boy in college, who often became paralyzed when he was faced with complex challenges. He had a tough time with the cognitive training program, but after a while he started learning new strategies and developing self-confidence, and showing marked improvement. Now, he can break complex tasks into manageable pieces . His attentional deficits appeared to threaten his opportunities in his family business. Unable to keep track of change at the cash register, lines at the business would grow and customers get angry, leaving him out of consideration for key start-up employment in the business. Now he can manage day-to-day challenges such as these, and the door to being part of the family business is now open. He can sequence tasks and execute then with a clear plan in mind, without being distracted and losing sight of that plan.

AF: Dr. Lavin, this is all very exciting news, that open the way for new interventions, new policies, a new understanding of what “education” and “learning” is and how to “educate” millions of young minds and equip them for life success. Thank you very much for your time.

AL: Thank you. I really appreciate all the work you are doing to bring the latest neuroscience research and applications to professionals like me and to parents at large.

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