Dr. Brunner has conducted ADHD evaluation for over 20 years as a qualified assessment expert.
Important Note: This story is about a adolescent and her mother who both gave this writer permission to tell their story.
There is no doubt ADHD is over diagnosed, but some children have genuine problems with remaining focused, organizing, and working through more complex tasks no matter how hard they try. It is not abut lack of motivation.
Luckily, there have been major advancements in how we help people improve their focusing ability, the leading non-medication based (but can be used alongside medication) advancement is called Cogmed (Cogmed.com). I’m going to share a story about a 16-year-old adolescent who underwent treatment with Cogmed five years ago and today is virtually symptom-free. I am writing this blog to give hope to those parents who have children – or who themselves have – ADHD or focusing problems. Not false hope, but real hope because Cogmed (also called Cogmed Working Memory Treatment) is based on a genuinely scientific breakthrough advancement that over 40,000 people have taken advantage of around the world. Cogmed utilizes the soundly proven reality that if you force the brain to carry out tasks it finds frustrating, it can learn and grow into becoming a higher functioning brain, not just at the moment but into the future.
The adolescent’s name is Meredith, and her mother is Dr. Tracy Ware, M.D. Dr. Ware is a psychiatrist in Chapel Hill, North Carolina. She found out about Cogmed after it was recommended to her for her adolescent daughter in 2008. Back then Meredith underwent psychological testing which identified a substantial discrepancy between her general intellectual ability score and her working memory score. In other words, Meredith’s intelligence suggested she should be able to focus much better than her scores indicated. Assessment like this is often how the problem first gets detected.
“Working memory” is the term used by behavioral scientists to describe the brain’s ability to focus on tasks in the moment. It is the brain’s “in the moment” memory, and is the gateway to all the other memories including long-term memory. In other words, if working memory is impaired then information is not going to be stored effectively in long-term memory.
Dr. Ware is on a research listserv which I am also a member of, and she recalls feeling excited about a method like Cogmed, which unlike medication was not simply trying to “muffle” symptoms, but actually go to the root of the problem by modifying the fundamental wiring of the brain to have long-term (i.e., years after Cogmed treatment over) effects. In other words, a medication approach to ADHD can make symptoms go away while you are taking the medication, but it does not try to address the fundamental neurological “wiring” issues. Cogmed does because it exploits the neuroplasticity of the brain, a proven ability the brain has to compensate for functional limitations by growing new or strengthening weak networks involved in tasks like focusing.
If you are a hard-core scientist and skeptic like myself, then you review the scientific data carefully, and you can go to this link to review the well-established and still quickly growing mountain of data supporting Cogmed: http://www.cogmed.com/research
As Dr. Ware recalls, “As a mother and a psychiatrist I was excited to see that someone was actually trying to do something about the major cognitive deficit in ADHD and signed her up, and Meredith was the first of a long list of kids and adults who have done Cogmed”
So what happened to Meredith after she completed Cogmed? Dr. Ware like many of us is a hard-core scientist. I have read many of her comments on the listserv we are both members of and can appreciate just how thoughtful she has in her approach. As Dr. Ware stated, “We all wonder how much difference the [Cogmed] training will make in the long run”.
Here is her summary: “I will skip all the stories and just go to the punch line. Meredith’s accommodations required re-testing this summer. Her behavior scales are now completely in the normal range, her IQ is up 15 pts and her working memory is normalized to 98th %ile, matching the 99th %ile IQ.” As Dr. Ware pointed out, while using the word “cured” is too strong a word, but her daughter now functions just like her peers. There were multiple improvements in planning ahead, organizing, goal setting etc. Basically, Meredith mother’s now says with pride, “If Meredith walked in off the street she would not be diagnosed ADHD based either on testing or behavior.”
Meredith does still take Concerta, a medication to help with focusing, but as Meredith’s mother who was also a highly skilled and realistic psychiatrist says, “I can see a day when she won’t need medication”. Concerta helps, but it did not teach Meredith new focusing skills as Cogmed does through repeated exposure to tasks that replicate real world memory challenges.
I join Meredith’s mother in hoping that one day we will have a new diagnostic category: “ADHD in full remission, courtesy of Cogmed Working Memory Training”.
Certainly Cogmed is not a cure-all, and it is only appropriate in certain cases. But simply using medication DOES NOT teach a child new skills, nor does it have lasting effects or make lasting improvements with the root of the problem in the brain. Furthermore, what you need to understand as a parent or an adult, is that medication is not necessarily the most effective approach, and is rarely the only approach.
Cogmed involves a dedication to hard work, it is a systematic approach. But we all know meaningful and lasting change only comes from hard work. Meredith, hats off to you for working so hard! Dr Ware, I thank you for being such a proactive mother who cared enough to research the best methods available.
Final note: You have maybe seen TV commercials for programs like Luminosity or Posit Science, which are similar to Cogmed. What you should do it evaluate the research. How do you do that? Read my blog on this very question: https://www.doctorbrunner.com/evaluating-scientific-credibility-in-an-age-of-misinformation-lessons-from-a-new-non-medication-based-adhd-treatment-called-cogmed/