By Sonya Collins
WebMD Health News
Reviewed by Hansa D. Bhargava, MD
Dec. 11, 2014 -- Kristy Lea was searching for a way to help her 5-year-old son improve his ADHD, and she wanted to reserve medication as a last resort.
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At the recommendation of her son's occupational therapist, she decided to try a cognitive training program from Cogmed. "It was another avenue to try to help my son with focus and attention that didn't involve medication," says Lea, of New South Wales, Australia. She promised her son a Star Wars Lego set if he completed the 5-week course.
"It's an expensive investment, but when you're a parent of a child with additional needs, you're willing to try something to see if it works," she says. Licenses for the program, sold only to schools or eligible doctors, run $900 to $1,500.
Cogmed, one of the most researched programs of its kind, is one among many computer-based cognitive training programs -- or brain-training games -- that aim to improve working memory. That's the part of short-term memory that allows you to hold onto information while using it. It lets you remember a phone number just long enough to dial it, while pushing out the distractions that would make you forget the number. Weak working memory is linked to some learning disabilities, and it can also be a part of ADHD.
Increasingly, therapists, school systems, and parents are turning to brain-training games to help children with learning challenges. K-12 school systems accounted for $195 million of revenue for the digital brain health industry in 2013. The K-12 segment of the industry is expected to grow by 20% per year, reaching $600 million in revenue by 2020, according to a report by SharpBrains, an independent market research firm that monitors the brain fitness market. About 40 of the 200 companies that SharpBrains follows market software for kids with learning disabilities.
Unlike most other programs, Cogmed is not sold direct to consumers. The program must be run by coaches, such as school teachers or psychologists. The company sells licenses to schools and clinical practices. Lumosity, one of its competitors, gives licenses to schools in exchange for their agreement to compile data for the company on student usage and results.
Those who purchase these types of brain-training games -- which can cost from a few hundred to more than a thousand dollars -- hope that improving working memory will make their child's learning disabilities less severe. That's what the game makers promise, but reviews are mixed.
"If you look at the [scientific research], the results are kind of all over the place. Some studies say they've found something significant, while other studies say they didn't find anything," says Michael P. Milham, MD, PhD. He's the director of the Center for the Developing Brain at the Child Mind Institute in New York.
Results may vary greatly in part because the success of the programs can depend on the individual child.
"You want to be careful. I'd judge it specifically by the case," Milham says. "The thing with ADHD is if you give [kids] a task they can't do, you could really discourage the child. If you have the wrong child doing this, you can wind up with some opposition or frustration. This may be well-suited [to some] but not necessarily everyone."
Age, personality differences, and even biological differences could impact how much a person benefits from working memory training.
A review of about 25 different experiments concluded that children ages 10 and younger can improve verbal working memory -- for example, the ability to remember and follow a series of spoken directions -- with these games more than children ages 11 to 18 can. This review included studies of Cogmed, CogniFit, and Jungle Memory, as well as a few other unnamed programs.
Several studies have shown that those with the weakest working memory can benefit the most from brain training.
Critics of working memory training argue that the skills kids sharpen with the games don't extend widely into other aspects of life.
"What they're learning is how to be good at the video games," says Rita Eichenstein, PhD. She's a pediatric neuropsychologist who specializes in assessing children with special needs. "Perhaps it exercises some very specific part of the memory system, but what we want is total development."
Some Brain Gains Reported
Studies do confirm smaller short-term benefits, though. The large review of about 25 different experiments says that "the programs produced reliable short-term improvements in working memory skills." Brain-training supporters say these gains should not be disregarded, as they may be transferred to academic skills.
In addition to memory, studies are looking at whether brain training can help children with focus. In a study of 26 kids, ages 7 to 14 with ADHD, those who completed the Cogmed program improved their ability to stay focused during schoolwork a few weeks later.
"We videotaped the kids in a simulated classroom activity. The kids in the treatment group looked away from their paper less often when they were left to do an assignment," says study co-author Chloe Green. She specializes in school psychology at the Bunge Lab at the University of California, Berkeley. "Looking away and wandering off-task are hallmark features of kids with ADHD who are inattentive."
A few studies have pointed to longer-lasting benefits of brain training for some children. About 60 kids ages 9 to 12 with attention troubles and special educational needs who completed 5 weeks of daily Cogmed working-memory training improved their scores on a math test immediately after the training. Boys, but not girls, continued to show improved scores 7 months later.
In another study, low-achieving students ages 9 to 11 who completed Cogmed working-memory training made greater progress in math across the school year than their peers who didn't do the training. The oldest kids in the group also made greater progress in English than their untrained peers.
'Not a Magic Bullet'
Still, there's not a consensus as to how long the improvements will last. And for all the studies that show benefits of these programs, there are others that show kids didn't benefit much at all.
"While there might be some promise or potential, this just hasn't been shown to a level of scientific rigor yet," Milham says.
Most studies, positive or negative, include relatively small numbers of kids. This makes a difference, says Mark Yaphe, general manager of customer lifecycle in Pearson Education's New Business and Innovation Group. Cogmed is owned by Pearson Education. "Often studies will not show statistical significance of the improvements made by Cogmed. They'll have improvements, but when you have a small sample size, you don't have significance."
Some studies that show few benefits of Cogmed include children with multiple learning disabilities. Cogmed doesn't recommend use of their product for children with multiple challenges.
Experts suggest that parents proceed with caution and manage their expectations.
"Learning disabilities are often lumped together when they advertise these programs, like, 'We will cure dyslexia, ADHD, auditory processing.' But you cannot capture all of these issues with one pill or computer program. There is no one single treatment that's going to address all of those things," Eichenstein says. Yet it's common, she adds, for kids to have several learning challenges rather than just one.
Yaphe agrees that Cogmed is not a cure-all. "We are not a magic bullet. We don't solve everything, but in terms of attentional issues, we create improvements. For people who have working-memory deficits, psychologists apply Cogmed as part of their broader intervention."
Parents who want to try the games must motivate and closely watch the child, not just park him in front of the computer and expect him to complete the program.
"It was a tough few weeks on the program," mother Kristy Lea says. But her son finished the course and earned his Star Wars Lego set.
"He was more able to maintain focus to read through an entire book and more interested in writing, and would choose to write notes now and then, which was something he hadn't done previously," Lea says.
But a little over a year later, "it's very difficult to say if the changes were long lasting," she says.
Offering her son a reward was the right choice, Milham of the Child Mind Institute says. "With some kids, if you put a proper reward structure in place, and they can tolerate this and they'll feel good about themselves, at least you'd know you're doing less harm."
SOURCES: Michael P. Milham, M.D., Ph.D., Director, Center for the Developing Brain, Child Mind Institute, New York, N.Y. Mark Yaphe, general manager, Customer Lifecycle, New Business and Innovation Group, Pearson Education. Rita Eichenstein, PhD, Dr. Rita Eichenstein, Ph.D., and Associates, Los Angeles, CA. Chloe Green, MS, Bunge Lab, University of California, Berkeley, CA. Kristy Lea, mother, New South Wales, Australia. Personality and Individual Differences.Developmental Psychology. Educational Psychology. Neuroscience and Behavioral Reviews. Egeland, J. PLOS One, Oct. 4, 2013. Neurotherapeutics. Journal of Education and Learning.Journal of Child Psychology and Psychiatry. National Center for Learning Disabilities.
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