Jumped the Synapse: Thoughts without sponsors!

These are my thoughts that don't fit in my other blogs. They'll eventually cover a large range of topics.

Friday, July 21, 2006

Does tutoring or the right kind cognitive training help ADHD?

Most of the assistance to date for ADHD children has either revolved around medication, behavioural therapy, or in academic settings, tutoring or special needs assistance. Is tutoring or training helpful?

a) Conventional tutoring
According to a 2002 study of 891 children, by Dr. David Rabiner of Duke University, conventional tutoring does help children with poor reading skills. However, he states that

“Tutoring was clearly less helpful for children with attention problems. As children's level of attention problems increased, the benefits of tutoring steadily declined. In fact, among children whose attention problems approached a clinically elevated range, there was virtually no discernible benefit of tutoring.

This should not be interpreted as demonstrating that academic tutoring cannot be helpful for children with attention problems. It does suggest, however, that tutoring may need to be more intensive, and/or that it may need to be specifically targeted to the special needs of children who are inattentive.”

b) Targeted cognitive training
On the other hand, there is emerging research evidence that points to the benefit of targeted training (rather than general academic tutoring) for those with ADHD. The NIH stated that:

“… given the evidence about the cognitive problems associated with ADHD, such as deficiencies in working memory and language processing deficits, … there is a need for application and development of methods targeted to these weaknesses”

In relation to those with brain injuries, the NIH previously stated that:

"Cognitive exercises, including computer-assisted strategies, have been used to improve specific neuropsychological processes, predominantly attention, memory, and executive skills. Both randomized controlled studies and case reports have documented the success of these interventions using intermediate outcome measures. Certain studies using global outcome measures also support the use of computer-assisted exercises in cognitive rehabilitation."

One study (Shaffer, et al., American Journal of Occupational Therapy, March 2000, 155-161) looked at the effect of a rhythm-based training program specifically designed for children with learning or attentional difficulties. The study examined 56 ADHD children who were given one of three treatments, one of which was a specific training designed to assist ADHD. The other two treatments were placebo or control-group orientated.

The study found that there was statistically significant pattern of improvement across 53 of 58 variables involving the training program. There were significant differences were found among 12 factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior.

Another study, conducted in 1993 at California State Polytechnic University, Pomona, California, by Drs. Aubrey Fine and Larry Goldman, related to the study of a specialized computer program designed to reduce ADHD. The study looked at 67 ADHD diagnosed children, who were given one of three treatments, one of which was a specific computer-based training designed to assist ADHD. The other two treatments were placebo or control-group orientated.

The conclusion by the reviewer, Dr. Joseph A. Stanford, was that this training was helpful to significantly improve the ability to focus and sustain attention, to encode and retrieve visual and auditory information and to increase the speed of mental processing. This training also significantly improved emotional and psychological functioning by apparently decreasing ADHD symptoms.

Another study published in the November 1999 issue of the Journal of Learning Disabilities (Semrud-Clikeman, M., An Intervention Approach For Children With Teacher- And Parent-Identified Attentional Difficulties. Journal of Learning Disabilities, 32, 581-590) examined the effect of targeted training on attention tasks. Participants in this study were 33 children in grades 2 through 6 who were diagnosed with ADHD, and 21 matched comparison children.

Attention training was conducted in after-school groups of 4 to 5 children that met twice a week for 60 minutes each time over an 18-week period. The training program utilized both visual and auditory attention tasks. The visual attention tasks required children to find a target stimulus embedded in an array of distracters. For the auditory task, children were required to count the number of times particular targets could be heard on a cassette tape. These are the kinds of repetitive, uninteresting tasks that children with ADHD
typically have great difficulty performing accurately.

The conclusion was that results from this study indicate that children with ADHD can perform as well as non-ADHD children on visual and auditory attention tasks following training in sustained attention and problem-solving skills.

... another random musing


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