Cogmed and ADHD. Well, maybe Cogmed +

Someone recently wrote to me about using Cogmed, a computerized training program to address problems with "working memory" and ADHD (Attention Deficit Hyperactivity Disorder or ADD) That's the part of memory that holds something in your head while you do something else - like hearing a phone number, getting a piece of paper and pencil and writing it down. One writer pointed out that Cogmed isn't designed for "curing" ADHD. The writer is correct, Cogmed training isn’t supported for helping with ADHD. When you are certified to provide the services, you are told not to make such claims. Sorry, generalization with these techniques is pretty poor. None of these "brain games" work well with something as complex as ADHD. But Cogmed is good for working memory, and if working memory is an issue improving working memory can really help. And sometimes working memory is holding someone back, get your working memory assessed and see if it's a significant part of the problem. Any registered or licensed psychologist can help you with that. (Regretfully many ADHD coaches seem to rush people off into using these programs when they are simply inappropriate. Make sure your ADHD coach is a registered or licensed mental health practitioner, and not simply someone certified in "coaching.") While there are always suggestions that some treatment will “fix” ADHD, one critical issue is always missed. ADHD is a developmental disorder. During normal childhood development,because of ADHD, a number of developmental skills are either not learned, or learned improperly. Because of core neuropsychiatric impairments in attention, inhibition and self-regulation individuals often fail to learn to use appropriate compensatory strategies to be successful at organizing, planning and managing procrastination/avoidance/distractibility. This leads to a functional impairments which none of these "quick fix" methods including neurotherapy, biofeedback, brain games, diets and supplements helps with. There is no pill or simple intervention to fix the functional impairments of ADHD and teach these skills, just like there is no pill to teach French, hockey or cooking. Organization is something you learn very early in life, usually in play, and it is reinforced naturally in the environment. (Parents clap, say ”what a nice job!” or the blocks stand up really tall!) When we work with an adult who might be having trouble at work with organizing, well, honestly, learning the skill is one thing, using it, is NOT reinforcing. Most of my adult clients need to deal with the fact that if they become more organized at work they will most likely ..... get more work! If you remember to do 10 things on your to-do list, it’s most likely not 10 “fun and exciting” things to do... and not terribly reinforcing things either. If they were, you would have done them. "Getting better can be a bummer," someone once said to me. And to top it off, then mood disturbances can develop. After a history of failure, underachievement, the development of negative thoughts and beliefs takes over (get the CBT manual out!). People really do need a coach, therapist or a very supportive friend to do this kind of work. Someone specifically trained in dealing with the cognitive issues involved in most mood disorders. A good program for ADULTS with ADHD should address medication, health and exercise, teaching organization and planning skills, working with multiple tasks, learning to prioritize, problem solve, reducing distractibility, understanding and gauging your attention span (there is a really neat device suggested by Russell Barkley called “The Motivator” - a timer/buzzer/reminder you wear to remind you to stay on task. Most of my clients love it!). Clients also need help modifying their environment to reduce distraction, and need help with adaptive thinking (it’s a frontal lobe issue!) It’s really a plate full. Usually the key to success, as Dr. Russell Barkley would stress, is externalizing key information. Giving clients something to rely on more than their own memory. About 1/2 of my practice is adult ADHD cases, and most clients come already taking medication or after using some other specific technique. Many spend a lot of time with these “brain games” and try all sorts of diets, supplements and “alternative” treatments. After some initial success, there are set backs. In the end, anyone seeing adults with ADHD should remember the majority of the work we will be doing together is old fashioned therapy - maybe people would call it “coaching” now - but it involves assessing and understanding the FUNCTIONAL deficits each client has, and not just implementing a single technique or intervention. It means addressing each, one after another. A good, structured approach works best, but there are simply no quick and dirty cures, fixes or ways to avoid the problems of ADHD. With the help of a properly trained mental health provider you can learn the skills you missed out on, improve those that you know to a degree, and together develop a holistic plan to make your life better, easier and more successful.