A new scientific journal on brain development launched in November.
Here's a podcast that summarizes that issue.
Tuesday, December 14, 2010
New Journal - Developmental Cognitive Neuroscience
A new scientific journal on brain development launched in November.
Here's a podcast that summarizes that issue.
Monday, December 13, 2010
The Dangers of "Mental Retirement" -- Our Brains Need to Solve Problems!
Freelance writer Sara Rowe recently posed some questions about dementia for an upcoming project. Here are some of my responses on that topic:
Q: What causes memory loss (both in the form of diseases such as dementia and in simple situations such as where you forget where you put your keys)?
A: Some decline in memory functioning is normal over the lifespan. A neuropsychologist can identify "normal age-related changes" beginning in the seventh decade (patients who are over 60). But these should be slight changes and not the sort of forgetfulness that has real functional impact. Frank forgetfulness is not normal in older patients and should not be dismissed. Among older patients, memory complaints may be related to reversible causes or more serious and progressive decline (dementia). Common reversible causes of forgetfulness among older adults include poor B vitamin absorption, sodium imbalance, and sluggish clearing of medications. Progressive memory decline is typically related to two common types of pathology: vascular changes (tiny strokes or insufficient blood and oxygen supply to brain tissue) and abnormal protein plaques and tangles. When the plaque-and-tangle changes are significant, doctors call that Alzheimer's disease.
And even among healthy older (and not so old) adults, transient forgetfulness may be a red flag of stress, depression, or overwork. Some people notice that after a poor night's sleep, or a night of drinking too heavily, they experience memory lapses and word-finding problems.
Just over 70% of the human brain is dedicated to "what is." We take note of the room temperature, what people around us are wearing, the nature of things as they are. The rest of our brain - the prefrontal cortex - is all about "what could be." I could end an unsatisfying relationship. I could move to Phoenix. I could move the piano over there so the door could open more easily into the room. The prefrontal cortex is the home of all that is magic about human cognition. And when our lives fall into a rut of predictability - when we're not solving problems and asking "what could be" questions, we run the risk of declining cognitive efficiency.
Q: What exercises/activities do you recommend to patients to sharpen memory and prevent or delay the onset of dementia etc.?
A: Several lines of research are coming together to suggest that complex mental activity is associated with reduced dementia risk. Cognitive Training refers to prescribed sets of mental activities directed at sharpening memory skills, reasoning, and speed of processing. Informally, many clinicians have encouraged their older patients to “stay active” by keeping their brain busy with crossword puzzles or Sudoku.
But in a recent study, Susann Rohwedder and Robert J. Willis discuss what they call "mental retirement." In the winter 2010 issue of Journal of Economic Perspectives (Abstract here and NY Times article here), Rohwedder and Willis suggest that retirement from vocational activity is associated with measurable decline in cognitive ability. There may be something about work that stimulates and protects the brain against age-related decline. And that may be something that crossword puzzles and Sudoku can't approximate. Vocational activity is an excellent cognitive workout. Work presents the brain - the whole brain - with sensory demand and motor planning challenge and time management and nuanced social problems.
My advice to anyone concerned about his/her memory is first talk with your doctor. She may ask questions and chart changes over time, or may refer you to specialists for further evaluation. You and your doctor will also try to stay on top of risk factors for memory decline: monitor and regulate blood sugar, maintain normal blood pressure, and keep cholesterol in check.
Meanwhile, the type of "brain exercise" I recommend is activity which is as organic and real-life as possible. If your life is not busy enough to require an alarm clock and a planner, then you are not busy enough to maintain brain functioning. At least 5 days a week, you should have a specific reason to be out of bed, dressed, and out the door. You should have enough going on that you need to keep a calendar to keep it all straight. You should be interacting with people who are a lot like you as well as people who are so different that you have to struggle a bit to figure them out. You should be solving problems every day. We need to avoid drifting into nostalgia and reminiscence; we need to keep imagining "what could be." That's what keeps our prefrontal cortex tap-dancing. Social problems, traffic logistics, travel planning, meal preparation....all of these give your brain the workout it needs to stay healthy.
The emerging concept of neuroplasticity recognizes that experience shapes our brain. Literally, at the level of the cell and synapse and brain structure itself, our daily learnings are shaping our brains. And although our brains don't regenerate as quickly and thoroughly as skin or even bone tissue, we do now recognize that the brain makes effort to heal itself and adapt to ongoing changes. At the risk of sounding trite, "use it or lose it."
Here's a real life story that illustrates the point (with identifying information changed of course!) Marion was surprised to find how dull retirement was. After looking forward to early retirement for several years, she found herself physically healthy but, at age 58, not as busy and engaged as she'd been while working a clerical position at a community college. She began to notice minor aches and pains and checked in with her doctor about these. She'd had checkups but had never had many complaints before, and her doctor questioned clinical depression. Marion complained of some amotivation and malaise but no real sadness. She did confide with her doctor, though, that she'd begun to worry about her memory. She slipped up with words that “I ought to know” and misplaced items in her apartment. She later recalled that she had started to see herself as “old,” and didn’t put much effort into grooming or maintaining her wardrobe. She’d been dedicated to her work at a local college and without that piece of her life, she realized she didn’t have many social outlets.
Marion responded to an ad in a local weekly paper to volunteer as a “baby cuddler” in a neonatal unit. The hospital was about a half hour drive from her home which she didn’t mind if she left early enough in the morning. She loved holding the newborn babies and felt relieved that, because this was volunteer work, there was no pressure to perform. But there were other mental challenges. She now describes her surprise at the cultural diversity and the different personality types among the staff and other volunteers at the hospital. Her coworkers at the college had all been “pretty much like me.” In her volunteer work, Marion found herself navigating social challenges, avoiding “putting my foot in my mouth,” and trying to coordinate her schedule to avoid working with one particularly bossy and overbearing nurse. Most of the staff was younger and Marion loved hearing their take on movies and politics and popular culture. They teased her about dressing “frumpy” and she began to take their advice and tips. To save money, Marion packed a lunch. And this meant planning ahead, prepping the night before, and coordinating grocery shopping around her volunteer work. She began to take delight in the little day by day prizes – finding a secret parking spot near the hospital back entrance, finding the coldest soda machine in the building, and picking up a few words of Portuguese in her conversations with one of the hospital staff members. Within weeks, Marion reported that her memory seemed “back to normal,” and she even felt less focused on physical aches and pains.
For folks who are approaching retirement, then, I'd recommend considering how to keep up the kind of mental workout that vocational activity involves. For example:
We need a specific reason - and deadline - to get out of bed in the morning. We need the challenge of having clean and pressed clothes ready. We need to interact with easy as well as difficult people. Our brains need problems to solve!
Q: What causes memory loss (both in the form of diseases such as dementia and in simple situations such as where you forget where you put your keys)?
A: Some decline in memory functioning is normal over the lifespan. A neuropsychologist can identify "normal age-related changes" beginning in the seventh decade (patients who are over 60). But these should be slight changes and not the sort of forgetfulness that has real functional impact. Frank forgetfulness is not normal in older patients and should not be dismissed. Among older patients, memory complaints may be related to reversible causes or more serious and progressive decline (dementia). Common reversible causes of forgetfulness among older adults include poor B vitamin absorption, sodium imbalance, and sluggish clearing of medications. Progressive memory decline is typically related to two common types of pathology: vascular changes (tiny strokes or insufficient blood and oxygen supply to brain tissue) and abnormal protein plaques and tangles. When the plaque-and-tangle changes are significant, doctors call that Alzheimer's disease.
And even among healthy older (and not so old) adults, transient forgetfulness may be a red flag of stress, depression, or overwork. Some people notice that after a poor night's sleep, or a night of drinking too heavily, they experience memory lapses and word-finding problems.
Just over 70% of the human brain is dedicated to "what is." We take note of the room temperature, what people around us are wearing, the nature of things as they are. The rest of our brain - the prefrontal cortex - is all about "what could be." I could end an unsatisfying relationship. I could move to Phoenix. I could move the piano over there so the door could open more easily into the room. The prefrontal cortex is the home of all that is magic about human cognition. And when our lives fall into a rut of predictability - when we're not solving problems and asking "what could be" questions, we run the risk of declining cognitive efficiency.
Q: What exercises/activities do you recommend to patients to sharpen memory and prevent or delay the onset of dementia etc.?
A: Several lines of research are coming together to suggest that complex mental activity is associated with reduced dementia risk. Cognitive Training refers to prescribed sets of mental activities directed at sharpening memory skills, reasoning, and speed of processing. Informally, many clinicians have encouraged their older patients to “stay active” by keeping their brain busy with crossword puzzles or Sudoku.
But in a recent study, Susann Rohwedder and Robert J. Willis discuss what they call "mental retirement." In the winter 2010 issue of Journal of Economic Perspectives (Abstract here and NY Times article here), Rohwedder and Willis suggest that retirement from vocational activity is associated with measurable decline in cognitive ability. There may be something about work that stimulates and protects the brain against age-related decline. And that may be something that crossword puzzles and Sudoku can't approximate. Vocational activity is an excellent cognitive workout. Work presents the brain - the whole brain - with sensory demand and motor planning challenge and time management and nuanced social problems.
My advice to anyone concerned about his/her memory is first talk with your doctor. She may ask questions and chart changes over time, or may refer you to specialists for further evaluation. You and your doctor will also try to stay on top of risk factors for memory decline: monitor and regulate blood sugar, maintain normal blood pressure, and keep cholesterol in check.
Meanwhile, the type of "brain exercise" I recommend is activity which is as organic and real-life as possible. If your life is not busy enough to require an alarm clock and a planner, then you are not busy enough to maintain brain functioning. At least 5 days a week, you should have a specific reason to be out of bed, dressed, and out the door. You should have enough going on that you need to keep a calendar to keep it all straight. You should be interacting with people who are a lot like you as well as people who are so different that you have to struggle a bit to figure them out. You should be solving problems every day. We need to avoid drifting into nostalgia and reminiscence; we need to keep imagining "what could be." That's what keeps our prefrontal cortex tap-dancing. Social problems, traffic logistics, travel planning, meal preparation....all of these give your brain the workout it needs to stay healthy.
The emerging concept of neuroplasticity recognizes that experience shapes our brain. Literally, at the level of the cell and synapse and brain structure itself, our daily learnings are shaping our brains. And although our brains don't regenerate as quickly and thoroughly as skin or even bone tissue, we do now recognize that the brain makes effort to heal itself and adapt to ongoing changes. At the risk of sounding trite, "use it or lose it."
Here's a real life story that illustrates the point (with identifying information changed of course!) Marion was surprised to find how dull retirement was. After looking forward to early retirement for several years, she found herself physically healthy but, at age 58, not as busy and engaged as she'd been while working a clerical position at a community college. She began to notice minor aches and pains and checked in with her doctor about these. She'd had checkups but had never had many complaints before, and her doctor questioned clinical depression. Marion complained of some amotivation and malaise but no real sadness. She did confide with her doctor, though, that she'd begun to worry about her memory. She slipped up with words that “I ought to know” and misplaced items in her apartment. She later recalled that she had started to see herself as “old,” and didn’t put much effort into grooming or maintaining her wardrobe. She’d been dedicated to her work at a local college and without that piece of her life, she realized she didn’t have many social outlets.
Marion responded to an ad in a local weekly paper to volunteer as a “baby cuddler” in a neonatal unit. The hospital was about a half hour drive from her home which she didn’t mind if she left early enough in the morning. She loved holding the newborn babies and felt relieved that, because this was volunteer work, there was no pressure to perform. But there were other mental challenges. She now describes her surprise at the cultural diversity and the different personality types among the staff and other volunteers at the hospital. Her coworkers at the college had all been “pretty much like me.” In her volunteer work, Marion found herself navigating social challenges, avoiding “putting my foot in my mouth,” and trying to coordinate her schedule to avoid working with one particularly bossy and overbearing nurse. Most of the staff was younger and Marion loved hearing their take on movies and politics and popular culture. They teased her about dressing “frumpy” and she began to take their advice and tips. To save money, Marion packed a lunch. And this meant planning ahead, prepping the night before, and coordinating grocery shopping around her volunteer work. She began to take delight in the little day by day prizes – finding a secret parking spot near the hospital back entrance, finding the coldest soda machine in the building, and picking up a few words of Portuguese in her conversations with one of the hospital staff members. Within weeks, Marion reported that her memory seemed “back to normal,” and she even felt less focused on physical aches and pains.
For folks who are approaching retirement, then, I'd recommend considering how to keep up the kind of mental workout that vocational activity involves. For example:
Volunteering
Active involvement in caring for grandchildren
Traveling
We need a specific reason - and deadline - to get out of bed in the morning. We need the challenge of having clean and pressed clothes ready. We need to interact with easy as well as difficult people. Our brains need problems to solve!
Sunday, December 12, 2010
Regional Variability of ADHD Diagnosis
I'm meeting clinicians in North Carolina this week and was interested to learn that is the state with the highest rates of ADHD diagnosis.
An expert in a recent article attributes this statistic suggests that heightened awareness among families, and better diagnosis by professionals.
And that's almost certainly part of the story here. But when we consider the state-by-state variability of ADHD diagnosis, or of stimulant therapy, there are likely other factors at play here. We notice, for example, an Eastern bias towards making the diagnosis.
This regional variability is an issue we touch on briefly in the workshop but I'm interested to hear the thoughts of my colleagues in North Carolina next week.
photo: psychiatric news
Friday, December 10, 2010
The Best Part of My Morning
My favorite moment of the day is my morning journaling practice. Three or four days out of the week I'm able to get to it. I have coffee, read a couple of newspapers, then open my journal. My practice is based on themes in the Positive Psychology literature.
I clarify some specific gratefulness, I remind myself of what I like most, and I commit to some specific way of being kind to myself and another person that day.
And my favorite moment is usually five or ten minutes into the practice when I feel a shift, like I'm settling down a bit more deeply into myself. Kind of a "oh yeh, that's why I'm here!"
This practice is, I think, part of my ongoing challenge to maintain a spiritual life. I got an early start, growing up in a minister's family. But the "pull" or the gravity of my life is to the dry and dusty details of daily commitments and tasks. I want to keep it juicy and alive. To feel the pulse of it all running just under the surface of the visible and quotidian.
Here's a link to my journaling template if you'd like to try it.
photo: january first
Thursday, December 9, 2010
Intrinsic Motivation! Magical Unicorns! Serial killers!
Elizabeth Báthory was a Hungarian countess who tortured and killed over 600 girls and women in the early 17th century. Clearly this was an individual with some disordered motivations. Ideally we'd like to see her develop empathy and other pro-social intrinsic reasons for not serially brutalizing others, but if the best we could do were keeping her behavior in check with extrinsic reward, well I'd settle for that. I really wish her parents had offered her music downloads or candy corns or 20 minutes past-bedtime play for every day she could go without hurting someone.
...read more at my Psychology Today blog
Wednesday, December 8, 2010
The Body Double
ADHD Coach Linda Anderson discusses the role of the Body Double here.
And there's a very helpful discussion of the Body Double concept in a BlogTalkRadio show from earlier this year right here
I've got a theory about how this works....it's the same way stimulant meds work. They "increase the saliency" of difficult or dull tasks. That is, at the brain level, one is more "in touch" with the medium- or long-term payoff of the activity.
Which is exactly what a good teacher or ADHD coach does! You know how organized and efficient you are the day before vacation? That deadline "increases the saliency" of work activities - even those which are dull or hard.
And you know how students tend to "tighten up" their behavior as the teacher moves physically closer to the student? As entertaining and rewarding it is to misbehave, there are rewards that I want even more than that....and the proximity of the teacher puts me in touch with those rewards (avoiding detention hall, or being seen as a "good kid"). That proximity "increases the saliency" of sticking-to-the-ground-rules in the classroom.
So my theory here is that the presence of the body double functions like that looming deadline or that nearby teacher...the Body Double increases the saliency of at-hand tasks.
I'm going to be kicking this around with clinicians who work with ADHD clients. And I'd love to hear from ADHD coaches out there!
photo: astronaut twins
Q & A: Homework Challenges
Here's a question from a recent participant in the ADHD and Processing Disorders workshop.
Q: Any suggestions for parents who struggle with homework issues with their ADHD children?
A: Our first piece of work is to determine where the student is breaking down. To ask "what's the kid's deal"? And to encourage parents to direct support to those points of performance.
In order for homework to get "done," a number of things have to happen. So when homework is not done reliably and painlessly, there are a number of common points where the project goes awry. The student might, for example:
Fail to write down assignments
Forget the assignment book
Forget necessary materials
Have trouble with the "getting started"
Take hours to do minutes of homework
Hassle parents about when and where to do homework
Lie about having done homework
Need constant supervision with homework
Forget to bring homework back to school
Our intervention will depend upon the student's specific way of not getting the homework done. The student with problems "getting started" might need strong incentives up front. And once he's actually dived into the task he might be more independent.
The student who gets the homework done (usually with good parental supervision) but who fails to get the material turned in the next day needs support with that piece. Faxing the homework to the school office in advance might help, or attaching the work to an email which can be opened, and printed at the school computer lab might be a fun way of getting the material to the teacher.
The student who lies to parents about assignments (I actually hear this complaint fairly frequently) is in a tough situation. She's doing something fun, or at least benign. And Dad asks whether she has homework. Now if she says yes to that question she will have to stop doing something fun and do something less fun, possibly even something hard. It's almost a set-up to tell a fib. I'd rather encourage teacher-parent communication. Some schools have websites for just this type of daily communication about assignments. So parents can maintain an overview of schoolwork there rather than using the student as the primary source of pure truth about necessary assignments which might be dull or hard.
Practical Tips
Ongoing school / parent communication regarding assignments and due dates.
Regular predictable routine regarding where and when homework takes place.
Limit distractions. If your student claims she performs homework better with simultaneous chat/IM or texting, you can definitely inform that in fact multitaskers perform worse on tasks than individuals who perform one task at a time.
Chunk cognitive activities. Commit to working on one single thing for a specified period (length of focused activity will depend on the age of the student). If you like cute, the Pomodoro Technique is a cute way to think about chunking.
Support the “getting started.” If your student has difficulty engaging with even moderate cognitive challenge - they drag their feet, use stall tactics, and so forth, you might consider rewards and incentives which are front-loaded. "I'll give you 4 iTunes downloads if you finish your math homework. And I'll give you 3 downloads just for opening your math text and taking out a pencil." For some students, this strong push to get started might be all it takes. Then, they're moving.
Each of has a specific recipe for success. Likewise we have a specific recipe for not getting things done. Mess with my recipe and you change the outcome. The goal here is find where exactly the homework isn't happening and direct support to that point of performance.
Subscribe to:
Posts (Atom)
Posts
