Effectiveness of Cognitive Processing Assessments and Interventions

Effectiveness of Cognitive Processing Assessments and Interventions on Academic Outcomes: Can 200 Studies be Wrong? (part 1 of a 3 part series)

As an educational psychologist working in Hong Kong parents and school staff often seek information on what sort of interventions may be helpful for their children or students academic difficulties. This includes children with ADHD, Dyslexia and Autism Spectrum Disorders (including Aspergers Syndrome). Schools in particular look for guidance in implementing Multi tiered support systems that involve various interventions and are part of a response to intervention (RTI) process. The use of research based interventions with some validity is an important part of the RTI process. In this series of three weekly blogs I will analyse and summarize a number of pieces of current research on cognitive processing assessments and interventions to help children develop academic skills. The first part will be an introduction, the second a look at the data and the third blog will explore the implications of this research.

The current national implementation of response-to-intervention frameworks in the USA has intensified the debate regarding underlying causes of student deficits and how to best assess and intervene for them. Several scholars have advocated for using measures of cognitive processing to analyse academic difficulties and design individualized interventions(e.g., Feifer, 2008; Fiorello, Hale & Synder, 2006; Floyd, Evans, & McGrew, 2003; Hale, Fiorello, Bertin, & Sherman, 2003; Hale, Fiorello, Kavanagh, Hoeppner, & Gaither, 2001). Feifer (2008) proposed using measures of underlying cognitive abilities for the purpose of selecting interventions and recommended several contemporary tests of intelligence, memory, and executive functioning to do so. There are also multiple resources available to school psychologists that describe interventions based on remediating underlying cognitive deficits. For example, there are books that list general reading interventions based on neuropsychology (Feifer & De Fina, 2007) and interventions for specific cognitive processes such as working memory (Dehn, 2008). Moreover, there were five mini-skills and documented sessions at the 2015 National Association of School Psychologists annual convention that provided free guidance on using data from cognitive measures to remediate reading difficulties, and multiple paid workshops at both the national and summer conferences with similar foci.

Meta analyses were proposed by Gene Class (1976) as a way to synthesize a research literature to better understand its findings. He proposed use of standardized mean differences in which the results of the study would be reported in standard deviation units that represented the difference between the treatment and control group. Cohen (1988) proposed the now famous d statistic, which is the difference of the two group means (control and experimental) divided by the pool standard deviation, and indicated that a d of 0.20 was a small effect, 0.50 was a moderate effect, and 0.80 was a large effect. Other metrics are also used, such as r and r2, but all approaches can be converted to each other for common comparisons.

If cognitive measures are useful to intervention planning, then experimental research should be able to demonstrate that use of cognitively focused interventions generate academic performance gains better than standard instructional practices that can be used in the absence of cognitive processing data (e.g., increasing corrective feedback, improving teacher clarity). Fortunately, there have been several recent meta-analyses regarding the role of cognitive measures to inform academic interventions. Next week a look at the data from these studies.

Assessing language skills in young children

Language and communication skills are essential to children’s ability to engage in social relationships and access learning experiences. Children with autism/asperger’s syndrome as well as Dyslexia may have difficulties with language development. Hence, it is a skill that is often an important part of assessments by Educational Psychologists in Hong Kong in order to determine the developmental progress of a child.

 

In a recent article in the Journal of Child and Adolescent Mental Health. It is found that current screening measures do not meet psychometric pre-requisites (psychometrics = design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and personality traits)  to identify language problems. A range of articles is reviewed to identify issues which practitioners and researchers should consider when assessing language skills. There are significant challenges in the interpretation of language assessments, where socioeconomic status, language status and dialect, hearing impairment and test characteristics impact results. The range of articles shows that psychometrically sound assessments of language are an essential component of developing effective and efficient interventions. Regular monitoring of language is preferable, as one- off screening has limited power to predict later performance because children’s developmental paths vary. Hence, a combination of language performance measures is a better indicator of language problems and disorders than single measures of component skills.

 

To conclude, the language system is complex, it composed of a number of subcomponents and the language paths of preschool children vary substantially. As such, the development of reliable and valid assessments is challenging, but they are of central importance for studying typical and atypical development. Research studies continue to enhance our understanding of the language development process and aid our identification of children who experience persistent language disorders and the factors that are associated with these. The assessment of narrative skills and dynamic assessment were highlighted as new developments. The current review has aimed to provide the necessary information to make informed decisions about assessing the language competencies of preschool children.

10 Things Parents and Teachers Should Know about ADHD

Core symptoms of ADHD

  • Hyperactive- impulsive: impaired ability to slow down and hold back
  • Inattention: impairments in prioritizing what to pay attention to, maintaining focus, block out distractions, remembering. Symptoms of inattention are usually most persistent and most problematic.
  • Symptoms get worse in situations that require sustained attention or mental effort or those that lack novelty and personal appeal (listening to teachers/ parents, classroom seatwork, homework, lengthy reading or listening activities, monotonous, repetitive tasks) .

 

The symptoms of inattention are most prominent

Many people think that all persons with ADHD have hyperactive impulsive behaviors that they have difficulty controlling. In fact it is the persons problems with focusing, concentrating, listening to directions, blocking out distraction, staying organized and working within time constraints that usually have the biggest interference with a person’s functioning.

 

 

ADHD is a spectrum disorder. Symptoms range from mild to severe. Key part of assessment is determining how much the symptoms have a negative effect on social, school or occupational functioning.

 

 ADHD people need more scaffolding than average

Scaffolding refers to a variety of instructional techniques used to move students progressively toward stronger understanding and, ultimately, greater independence in learning. In early childhood, caregivers perform functions for the child. Showing, directing, helping, reminding, coaching and critiquing are means of scaffolding. Examples include, walking, getting dressed, crossing street, riding bike, driving car. Scaffolding is gradually withdrawn, as child becomes able to (or is forced to) perform these functions for self. In adolescence and adulthood scaffolding provided by: friends, teachers, coaches, spouses, supervisors and computers.

 

 

Prevalence and demographics of ADHD

  • All level of IQ, but most would be average or above
  • 70%- 90% male
  • Found in all countries and ethnic groups
  • Highly heritable (87%)

 

Types of proven treatments for ADHD

 

  • Parent/ Teacher training about ADHD
  • Parent training in child management (young children)
  • Parent/ Teacher training in behavior management
  • Adult input with self monitoring
  • Medication

 

 

Important considerations for teachers

 

ADHD is a biologically based disability that is treatable, but not curable. The goal of school intervention is to contain and manage the symptoms. ADHD is not due to lack of skill or knowledge, but is a problem of sustaining attention, effort, and motivation and inhibiting behavior in a consistent manner over time. ADHD symptoms are particularly bad when consequences are delayed, weak or absent and material is perceived as uninteresting. It is harder for ADHD students to do the same social behavior expected of other students. ADHD children need increased adult direction, structure, more frequent and salient

consequences, and accommodations, for assigned work.  The most effective behavioral interventions for improving school performance are those applied within the school setting.

 

What can teachers do to help?

  • Keep a disability perspective (an explanation, not an excuse)
  • Interact on positive level as frequent as possible (immediate, frequent, consistent feedback about behavior and performance)
  • Anticipate problem situations and structure for success
  • Make sure you have attention before giving directions (say child’s name before giving directions to the group)
  • Use desirable activities as reinforcer for work production and appropriate behavior
  • Break things into small units (less problem on a page)

 

Importance of Behavioral and Combination Interventions

Ongoing behavioral interventions may increase the possibility of tapering off medication if it is being used or stopping them as children age.

 

 

What to do if I feel someone I work with has ADHD and needs help?

  • Consult with colleagues and see if they see the problem as well
  • Suggest professional assessment and describe observed problems in specific behavioral terms
  • Don’t get caught up in deciding what treatment should be obtained
  • Teachers should not tell parents their child needs medication.

Emotion Regulation in Autism Spectrum Disorders

Difficulty regulating emotions has not always been defined as a significant feature of autism spectrum disorders, but there is growing evidence that emotional problems play a prominent role in this disorder. Hong Kong is no different as many children who are referred have difficulties with controlling their mood and emotions. This is also the case for children that have related disorders such as ADHD.

In a recent study published in the Journal of Child psychology and psychiatry a wide range of emotional regulation strategies were examined in children and adolescents with autism spectrum disorders and were compared to typically developing peers in 3 emotional domains (anger, anxiety, and amusement). Parent interviews and child daily diaries were used to examine emotional experience in the use and efficacy of 10 emotional regulation strategies. Children and adolescents with autism spectrum disorders had significantly different emotional regulation profiles compared to typically developing children in all 3 emotional domains, characterized by less frequent use of adaptive methods (problem solving, cognitive reappraisal) and more frequent use of maladaptive strategies to control their emotions (repetitive behaviors).

This study adds to the already growing body of literature documenting that individuals with autism spectrum disorders (as well as ADHD) have maladaptive emotional regulation profiles. The above study is consistent with with my clinical experience working with both children that have autism spectrum disorders as well as ADHD in Hong Kong. In most cases when high functioning individuals on the autism spectrum (Asperger’s syndrome) are referred when they are adolescents or young adults, one of the common concerns is how to deal with high levels of anxiety that are having a negative effect on their functioning.

Hopefully the above research will offer some insight that will improve individual interventions that promote wider understanding and contribute to the evelopment of more adaptive strategies to help individuals with ASD manage their mood and emotions.

What happens to children diagnosed with ADHD when they become adults?

What happens to children diagnosed as ADHD when they become adults?

The first Large, population-based study to follow children with attention-deficit hyperactivity disorder (ADHD) into adulthood shows that of the children studied, only 37.5% reported that they were free of the disorder in adulthood. The long-running study followed 5728 children at age 5, who were born in Rochester, Minnesota between 1976 and 1982. The study population was relatively heterogeneous and largely middle class, and the children tended to have good education and good access to health care. 367 were diagnosed with ADHD and, of this group, 232 participated in the follow-up study. About three-quarters had received ADHD treatment as children. At follow-up, the researchers found:

l 29% of the children with ADHD still had ADHD as adults (ascertained through structured neuropsychiatric interviews)

l 57% of children with ADHD had at least one other psychiatric disorder as adults, as compared with 35% of controls. The most common were substance abuse/dependence, antisocial personality disorder, hypomanic episodes, generalized anxiety and major depression

l Of the children who still had ADHD as adults, 81% had at least one other psychiatric disorder, as compared with 47% of those who no longer had ADHD and 35% of controls

l 7 of the 367 children with ADHD (1.9%) had died at the time of study recruitment, 3 of them from suicide. Of the 4,946 children without ADHD whose outcomes could be ascertained, only 37 children had died, 5 by suicide

l 10 children with ADHD (2.7%) were in the judicial system at the time of recruitment for the study.

Important points from this study are that about 70 % of the patients diagnosed as ADHD as children no longer met criteria for the disorder. I find that this fits with informal data from my own clinical practice where I have tracked some children into adulthood. Other colleagues in a similar child psychology practice agree. It is disheartening to see that over 80% of those diagnosed as ADHD as kids that still met criteria as adults had other psychiatric problems. Source: April 2013 issue of Pediatrics.

Strattera as Treatment Option for Young Children with ADHD

Some of the children that I work with in Hong Kong as an Educational Psychologist benefit from treatment with the relatively new non-stimulant medication Strattera. A study completed within the last 2 years suggests that Strattera (which is now approved for children age 6 and under) can reduce ADHD symptoms. Strattera, Treatment in Young Children an eight week study with 101 children between age 5 and 6 who were diagnosed with ADHD, found that treatment with Strattera reduced ADHD symptoms. Unfortunately, the results were not overwhelming. It was suggested that 40% of the children treated with Strattera were “much” or “very much” improved on a behaviour rating scale completed by parents and teachers compared with 22% of children who took a placebo. Unfortunately, because the study was small, the percentage of children in the “much improved” or “very much improved” category was not statistically significant.

The impressions of the researchers were that overall the medication did reduce symptoms of ADHD in the children who took Strattera and there were not a significant number of side effects in the majority of children. They concluded that Strattera could be considered a safe treatment option for young children with ADHD.

This study provides us some important information on the safety and effectiveness of Strattera in treating children with ADHD. Unfortunately Strattera does not have the quick and dramatic effect that stimulants can sometimes have on children’s behaviour but it can be quite helpful for any child that may not respond to stimulants. Most physicians still advocate starting with stimulants in young children with ADHD and we should never forget that medication should always be combined with behaviour therapy and parent training.

 

Side Effects of Medication for ADHD: What Does the Latest Research Say?

Medication as a treatment option for ADHD is not used in Hong Kong as extensively as it is used in western countries. However, as an Educational Psychologist working here for many years I am often asked to give information to parents about the therapeutic and side effects of these medications. What follows is a summary of some of the latest research published in the Journal of Child Psychology and Psychiatry.

Appetite and sleep disturbance are the most common side effects when using psycho stimulant medication such as Concerta.

Loss of Appetite
Typically the loss of appetite starts to get better the longer the child stays on medication and most of the time the positive outweighs the negative. Important factors to keep in mind are differentiating between pre-treatment eating problems and medication induced eating problems. In my experience it can be difficult to get the child to eat during the day when the medication is at its peak efficiency. Giving medication after meals and encouraging use of high calorie snacks (even late evening meals) can sometimes be helpful.

Sleep Disturbance
The research says (and in my clinical experience) that treatment with stimulant medication does not necessarily disrupt overall sleep in the majority of children but it may induce problems falling asleep in individual cases. Analysis of data between studies shows some inconsistent findings but there have been some that actually suggest that there is a beneficial effect of medication on overall sleep in some children. As with poor appetite it is best to assess whether or not the child had sleep difficulty before they started medication. Encourage parents to keep a sleep diary and if the problem persists it may be necessary to switch to a different type of medication.

Motor Tics
Motor tics are an uncommon side effect with stimulant medication. I have seen it occur in some children with ADHD but in my clinical experience it seems to occur a bit more often with children with Aspergers Syndrome and other autism spectrum disorders. Some children with ADHD present as having motor tics before they start medication and parents often ask if the medication will increase tic activity. The latest research says that there is no evidence that stimulant medication worsens tic severity in the short term. If tics occur it is best to observe the intensity and take some data on the frequency and ask your physician about reducing medication or substituting a different type of drug.

Adverse Cardiovascular Events
Some have suggested that using medication may increase the risk for adverse cardiovascular events. At present the empirical evidence does not support an association between psycho stimulant use and clinically significant changes in EKG. Several recent studies found no evidence that current use of medication for ADHD was associated with a risk of severe cardiovascular events.

Alternative Medications for ADHD and side effects
What about Strattera? Strattera is a relatively new non stimulant treatment for ADHD. Typically Strattera is not the first line drug that Physicians use to treat ADHD symptoms but I have found it to be quite helpful for many children especially those who had a poor response to one of the stimulants such as Concerta. In my clinical experience Strattera has been particularly useful for children with autism spectrum disorders such as Aspergers. Side effects from Strattera include dry mouth, upset stomach (nausea) and sometimes loss of appetite. Urinating less than usual or not at all as well as shortness of breath may sometimes be present. However, for the most part Strattera has less side effects than the stimulant drugs as reported in the research and this is consistent with my clinical experience.

Practitioner Review: Current Best Practise and the Management of Adverse Events During Treatment with ADHD Medications in Children and Adolescence, (2013). Cortese, S. et. al. Journal of Child Psychology and Psychiatry, 54, 3, pages 227-246.

5 Important Things To Remember When Helping Teens With ADHD

Teenagers in Hong Kong that are diagnosed with ADHD often find it difficult to keep up with the demands of secondary school and typically underachieve. As an Educational Psychologist I am often asked what schools can do to help these students.

Establish a mentor or contact person (school counsellor, subject teacher, educational assistant, resource teacher) with whom the child has good rapport. Setting up regular meetings (twice a week) is suggested. The child should be checking in with this person at a specified time to discuss the requirements for each class and the progress being made on short and long term assignments. This contact person could also have contact with the child’s subject teachers to help make sure the child is keeping up with requirements.

Key Points To Remember:

1. The mentor or contact person should also keep some kind of visual records (graphs) of the student’s progress towards meeting goals (handing in assignments, favourable feedback from teachers, increases in scores on assignments that involve writing) and this should be reviewed with the student on a regular basis. Be sure to include the student in establishing goals.

2. Establish a specific time each day for homework completion. This usually works best if it can be done before the student leaves school. If homework must be completed under parents’ supervision there should also be a specific time established for completion. Try to keep to a set time limit and have the student complete whatever they can during that time. Avoid conflict over homework issues to the point where it results in negative emotions between parent and child. Keeping a graph or chart of the child’s progress and compliance in completing homework can be helpful.

3. Teachers should clearly communicate task parameters. The student should know exactly where they need to start and finish, how much is to be done and the estimated time involved to complete the task. Encourage the student to sit in the front of the room near the teacher so that you can provide regular prompting. Try to keep the student away from peers who may easily distract them. Once you have given directions for a task approach the student and confirm that they have understood and provide some extra monitoring of their progress.

4. If at all possible it can sometimes be helpful for the student to be able to access some desired activity (especially for homework) based on adequate attention to tasks and completion within time frames. This is particularly important for tasks they find difficult such as writing assignments.

5. Be positive. Research has consistently shown that children with ADHD receive many more control statements from adults than a typical child. For a teenage child with ADHD (especially one who may have gone undiagnosed for a long time) their attitude towards school and learning can sometimes be quite negative. Some of this may be due to the multiple directions and control statements as well as unfavourable feedback they have received from parents and teachers over the years. Try to be conscious of the comments that you make to the student and praise them as much as possible when they demonstrate appropriate vigilance to tasks and attentive behaviour in the classroom.

Following these guidelines will certainly help ensure a positive learning for teens with ADHD. For more information, please feel free to contact us at info@childandfamilycentre.com.hk.

Improving Written Language in ADHD Children

Written language skills are often an area that is in need of development for children with ADHD. As an Educational Psychologist working with students that attend Hong Kong International Schools, I meet a great many teachers and parents seeking strategies for improving this area of a child’s functioning. In my continuing series on non-medical interventions for ADHD, the next few articles will focus on developing written language skills.

The study outlined in this article was published by Graham Harries in the Handbook of Learning Disabilities. The technique utilised was called Self Regulated Strategy Development (SRSD). There were three children in the study with ADHD who scored below the 20th percentile on written language tests and they were all taking medication. The target of the study was to measure increases in number of story parts and words and whole quality.

Students were taught goal setting, self monitoring and reinforcement. The intervention was implemented for nine weeks with the emphasis on effort and strategy use in learning as well as making the improvement visible through self monitoring and graphing. Mnemonic devices were used such as “POW”, “Plan my Ideas”, “Organise my Notes”, “Write and Say More”. The instruction was provided by teachers and teaching assistants and strategies and responsibility were slowly shift to the student at their pace. Basically the students were taught to self monitor the number of story parts and number of words they used in written expression tasks. The results were graphed as they moved along so that they had on going performance feedback. This helped the students learn to write more independently and automatically and they could have guided practice until they achieved mastery.

Results suggested that two out of three students in the study showed increases in their written expression skills and there was also some decrease in overall inattention symptoms based on teacher ratings.

Studies such as these using behavioural interventions for ADHD help to provide further evidence that non-medical interventions can be useful in helping these children cope with their difficulties. Interventions such as the one described above are certainly not a quick or inexpensive fix, but if schools are willing to put a bit of resources into these sorts of interventions it can likely provide short and long term benefits to children with ADHD.

For more information, feel free to check out these resources.

Computer-Based Cognitive Training Programme For ADHD And Other Disorders: Are They Effective?

It is an intriguing thought to consider that we may be able to improve the cognitive and executive function difficulties associated with disorders such as ADHD without using medication. Over the last seven to ten years a number of commercially available cognitive training programmes are now available to the public. In Hong Kong there are several psychology clinics that promote these interventions. The programmes are marketed as having research evidence documenting their effectiveness for children. They involve “brain training” in systematic and repetitive game style activities that target some specific cognitive domain such as attention or working memory. These skills are sometimes referred to as “Executive Functions” of the brain. Executive function is a term that is becoming more and more familiar to parents and educators. This refers to persons’ internal capacity to regulate their attention, working memory, organisational skills and emotions. Research has clearly shown that these skills are impaired in children with ADHD, Autism/Asperger Syndrome and Dyslexia. Computer based cognitive training programmes make claims that they can increase or improve a child’s abilities related to executive function.

These programmes can be quite attractive to parents and even schools as they seem a low risk, less invasive treatment versus medication or traditional behavioural intervention that requires a lot of increased adult involvement in a child’s life. The theoretical background for development of these programmes comes from the increasing body of evidence from neuroscience that environmental experiences and interventions can alter brain development. But do these programmes really work? Is there enough solid research evidence such that professionals working in mental health and education should be recommending these as an evidence based treatment for attention or other cognitive difficulties?

There are several commercially based cognitive training programmes that have some research published on their effectiveness including: Cogmed, Jungle Memory, Captain’s Log and Brain Fitness Pro-Junior. Cogmed which utilises computer games that are targeted at increasing working memory has the largest number of studies in the research literature. The problem is that in many of these studies the research methodology is somewhat lacking making it difficult to draw specific conclusions about the programme’s effectiveness. What some studies do show is that computerised cognitive training programmes result in short term performance improvements on the tasks that are involved in the programme and can also increase working memory and attention if the tasks are similar to those that are used in the training programme. Providers of these commercial training programmes suggest that this indicates that there are changes in brain structuring as a result of the programme. Therefore this increases the efficiency of a participant’s working memory and attentional systems. That should then transfer to related abilities such as attention and organisational skills in the classroom, regulating behaviour and increased academic performance.

The best study to date that document the effectiveness of cognitive training programmes on working memory is by Dr M Melby and will be published in the Journal of Developmental Psychology. This is a meta-analysis which means thirty studies that met crucial research criteria such as inclusion of a control group and randomised assignment were analysed. Results suggested that there were some immediate training effects for verbal and visual spatial working memory tasks. The evidence was strongest for children that were 10 years old or younger but overall there were no long term benefits after implementation of the programme. They found some small effects and generalisation to related reasoning tasks but the effects disappeared when a control group or randomised design was utilised. There were no improvements on verbal reasoning, word reading or arithmetic and it was concluded that the evidence does not support the notion that working memory, computer based cognitive training programmes produced significant positive outcomes on related tasks that typically involve working memory.

There were only a handful of studies attempting to document the effectiveness of computer based training programmes on core ADHD symptoms. These are studies that included control groups and had random assignment. One study included thirty six 6 to 13 year olds with ADHD and utilized a combination of non commercial attention training tasks The outcome suggested that those in the treatment group had increased reading comprehension and passage copying skills and parent’s ratings indicated a reduction in attention problems. The intervention took place for eight weeks but there was no follow up data or teacher ratings or measures of school performance included as measurement criteria.

In the second study utilising Captain’s Log, 6 and 7 year old children who were rated as inattentive by their teachers were randomly assigned to a computerised training programme, a computerised academic intervention or a waitlist. Results suggested that the children participating in the computerised training programme significantly reduced their inattentive behaviour based on teacher ratings. However, positive gains in their attentional skills did not sustain at follow up.

In another study, forty one middle school age students with ADHD were assigned one of three conditions (Neuro Feedback, Captain’s Log Computer Training or Wait List). There were various rating scales used as outcome measures. Children in both the Neuro Feedback and Computer Training Programme a lot of evidenced improvement in their behaviour based on parent’s ratings but this was also the case for the Wait List control group. However, teacher’s ratings suggested that there were no significant improvements for any of the three groups before and after the interventions.

The pattern appears to be same for studies on the outcome of improving attention as it is for working memory. Short term immediate effects on some measures of similar tasks are noted but there is not solid evidence for long term improvement. Evidence for overall improvement in academic functioning was only noted in one study.

Putting all of these results together, it appears that computerised cognitive training programmes can produce some changes in attention and overall executive functioning in the short term but to say that they are reliable and valid and there is evidence of transfer to improved school functioning does not appear to be the case at present. This is in marked contrast to the claims of the vendors of commercial cognitive training programmes. Overall, there are many questions that remain about the clinical utility of these programmes. The problems with the studies that are put forward as evidence by the marketers of these programmes is that they have methodological flaws such as lack of control groups, single measures of cognitive constructs and inconsistent transfer to tasks across studies. Researchers question whether the short term benefits of cognitive training programmes are really evidence of underlying changes in brain function as opposed to something as simple as a practise effect with certain tasks.
In looking at the working memory tasks that are included in many of these programmes they are relatively simple. Researchers question how potent they can really be given that executive function and related cognitive skills are quite complex and involve many components of our nervous system. Intuitively it can be hard to accept that a relatively simple cognitive task could have a significant overall impact on a complex system such as executive function and lead to significant changes in a person’s day to day ability to focus, attend, block out distraction, regulate behaviour and perform academically.

Perhaps computerised cognitive training programmes could someday help remediate cognitive and behavioural deficits associated with ADHD, Autism and other related disorders and continued development of research in this area should be encouraged. Unfortunately, at present the existing research with properly designed peer reviewed studies is limited. Parents and professionals should therefore be careful in recommending commercially available computer based cognitive training programmes and consider the costs versus the potential benefits before making a decision in utilising them for treatment of their children’s difficulties.

References:

Melby-Lervåg, M., & Hulme, C. (2012). Is working memory training effective? A meta analytic review. Developmental Psychology. Advance online publication. Doi: 10.1037/a0028228
http://www.apa.org/pubs/journals/releases/dev-49-2-270.pdf

Shalev, L., Tsai, Y., & Mevorach, C. (2007). Computerized Progressive Attentional Training (CPAT) program: effective direct intervention for children with ADHD. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 13,382-388
http://www.ncbi.nlm.nih.gov/pubmed/17564853?log$=activity