So You're Thinking About Train-the-Brain Therapies?

“Training-the-brain” is without question, a good thing to try to do… and we all do it all the time. Think about the first time you flipped an omelet… it got easier the more you practiced, right? And knotting a tie? How about learning to drive a car, or heading out on ice skates or the ski slope? The human brain is comprised of more than 100 billion cells (neurons) each of which is connected to thousands of nearby cells as well as to many millions of other cells in almost every other region of the brain. Think about it: more than 100 trillion connections, sending and receiving information 24/7, every day of our life. Every time we engage in an activity, no matter how small or seemingly effortless, we’re not just using one part of our brain. Our brains are flooded with an almost constant stream of information, and while certain areas of the brain have been shown to be more active during certain types of tasks, we are still learning about the particular roles that certain areas and structures in the brain play during learning.

Underlying these types of approaches is the assumption that “practice makes perfect” and even though we’re not quite sure what specific areas of the brain we are targeting, we imagine that engaging the brain in workout sessions will result in better, faster, more efficient thinking and learning. The problem with this reasoning is simple: the brain is not a muscle and providing it with practice (like swimming laps in a pool, doing sprints around a track, or spending hours developing the perfect jump shot) is not going to improve your ability to do anything but, well, engage in the tasks that you’ve been practicing as part of the program.

What We’re NOT Talking About There are lots of software programs and mobile apps that provide skill building instruction and practice in areas such as reading (decoding and comprehension), writing, and math. They provide immediate feedback to the user and can be tailored to the individual in terms of reading level, pace of instruction, and types of feedback provided. Select the right programs, implement them with fidelity, provide additional “human” support and feedback, and you’re almost sure to see some positive results.

What We ARE Talking About Then there are programs that are intended to improve skills that underlie areas of weakness and allege to improve brain function that, in turn, make it easier for individuals to benefit from instruction. And here’s where the rubber fails to meet the road. The little scientific proof we have about effectively training or retraining the brain comes from “recovery of function” studies with patients who have suffered from strokes or other cerebral accidents, have undergone brain surgery or other types of treatment, suffer from diseases that affect brain functioning over time (such as multiple sclerosis), and who suffer from progressive forms of dementia. We do not yet know how to target treatments to otherwise healthy individuals who struggle with learning, attention, memory, problem-solving, organization and different types of perception and judgment.

What Areas of Cognitive Processing Do These Types of Programs Target for Improvement? The list includes:

• Attention, concentration and impulsivity
• Motivation and perseverance
• Short-term (working) memory
• Visual and auditory information processing
• Analyzing and organizing information
• Problem solving
• Self-checking and self-monitoring strategies
• Building awareness of possible repair (self-correction) strategies
• Planning and implementing strategies for studying and time management

It makes sense that providing practice doing increasingly difficult tasks in each of these areas might help, but the jury is still out when it comes to answering the following key questions:

• For which individuals are these treatments proven to work?
• Does the ability to perform well on these tasks during training translate into enhanced skill in real life situations?
• If benefit is reported by the individual who has undergone training, will the results be sustained over time and will the person be able to apply this new ability to new and different situations? (The answer to this question is critical to even trying to determine whether the “brain” has been “trained” in some way.)

Trial and error cannot answer these questions, and until we have better science to prove or disprove a particular treatment, parents and educators are left to shoulder the burden of figuring out whether or not to try a particular therapy or approach.

To Train or Not to TrainStep 1:

If you are ready to try one of these train-the-brain approaches, it means that you have already come to one of these conclusions:

• The root of the problem is some underlying weakness or immaturity (in the brain) that can be fixed (or helped).
• Remediating this lower-level weakness (how the brain processes a particular type of information) will improve the ability to perform higher level skills (such as reading and math).

There is no reason to discourage people from trying these types of approaches if they believe there is some benefit to be gained… just “consumer be informed and beware” especially if the training promises a “fix” or “cure.”

The potential value of these types of programs is that they condense activities and practice into time-limited games or challenges, and provide feedback that keeps the user engaged and wanting to do tasks over and over, at increasing levels of difficulty. Do they help? Well, people who play video games that involve shooting or driving, even for a relatively short time, have shown improvement in their ability to search for a target hidden among irrelevant distractions in complex scenes. Does this ensure better attention or decision making on the soccer field or while engaged in reading complex social studies or science texts? (I bet you know the answer!)

Step 2:

Think about the potential benefits and then reflect on some of the questions and concerns below.

Potential benefits of these treatments	Questions/Concerns
They provide practice in areas of functioning that are determined to be weak. Rather than running from or avoiding things that are hard to do, these types of treatments encourage people to learn why and how they struggle – and insight is always a good thing.	Practice in “thinking” or “cognitive processing” has not been proven to translate into improved “knowing” or “doing.” For example, improving speed, accuracy and automaticity when clicking on a video screen is not going to make you a better, faster, or more accurate and efficient reader. Might it “prime the pump” for learning to read? (Perhaps, but there are no good scientific data to suggest they would.)
They reinforce the importance of paying “attention,” improving “listening” and enhancing “memory.”	Attention, listening, memory, and other such skills that are “trained” via these types of programs are situation specific. In other words, being good at the training exercises does not mean you’re going to be good at doing these same things in other settings or when faced with other, real-world challenges. (Some promising study in this area is ongoing with the Cogmed program.)
It makes enormous sense to try to build competencies in these areas.	If any benefit is to be gained, it is most likely to be with populations who demonstrate profound weakness in these areas (those with autism spectrum disorders, traumatic brain injury, and perhaps individuals who have serious language and/or communication disorders for whom highly-targeted training approaches like Earobics and FastForward have some good outcome data.
They are often easy and fun to do.	We like fun, but not if it takes time away from activities that could be more strategic and that will translate into measurable impact, such as improved time on task for homework, better note-taking, and better self-monitoring of performance.
The electronic formats allow for easy access and immediate feedback.	Feedback is essential but not at the sacrifice of real life, interpersonal interactions. Think about the difference between a kind or encouraging word, tap on the back, or smile from someone who can model a behavior or say “Let’s do this together” compared to a “You Won!” flashing on an LCD display.
It can’t hurt.	But for whom is it likely to help? What specific types of weakness, in what particular type (or age) of learner, are most amenable to improvement given what particular type of brain training, over what period of time, and at what cost? Will any gains in “thinking” achieved be sustained over time? What else could I be doing that has a proven track record of success and strong efficacy data? How will I know whether it’s working or not, and when will I know to stop? (Please don’t say “when I get bored” or “when the money runs out.”)
They can lead to feelings of accomplishment and self-confidence about having completed the training.	True, but what if performance does not improve? There is the very real possibility that less than optimal results can lead to even greater self-doubt, trigger (or reignite) feelings of incompetence, and feed feelings of low expectations.

The bottom line about “train-the-brain” programs: We don’t yet know how to train cognitive skills in individuals with LD or AD/HD. We cannot say which individuals will benefit from these types of training, whether the benefit transfers to real-life situations, and whether any benefit realized will last over time. Unless studied carefully, we cannot attribute any changes we see in individuals to the use of these types of programs. If you’re going to look for train-the-brain programs, avoid those that promise to help balance the brain, improve brain efficiency, enhance brain integration, restructure brain circuitry, repair cerebral disconnections, stimulate growth in brain circuitry, improve brain fitness and processing efficiency, or those that say they can fix anything but the kitchen sink. These types of programs can be very engaging and lots of fun! Just know what they can and cannot do before you schedule time for your child in front of the computer.