May 15, 2023
For nearly 40 years, I have assisted families as a pediatrician in general practice. One of the most common and challenging concerns parents bring to me is their child’s difficulties in school. There are numerous reasons for this growing issue, including the increasing complexity of work demanded from younger children, the pressure to secure substantial employment and attend a top college, the disappearance of play from childhood, and growing evidence that some of the 85,000 chemicals we are now exposed to impair key cognitive functions. But whatever the reason, a not so silent epidemic of school struggles continues to rise. It is evident in the dramatic increase in ADHD diagnoses and the prescription of powerful drugs like amphetamines for millions of children, many quite young.
Throughout my career, I have prioritized learning how to help struggling children and their parents understand the causes of their difficulties, and find solutions. Over ten years ago, I had the honor of being appointed to the American Academy of Pediatrics (AAP) committee responsible for developing policies regarding the social and psychological well-being of the nation’s children. I recently completed a term as chair of this committee, and during my service I authored a paper that still remains in force as the AAP’s official policy. The paper establishes the standard that pediatricians consider the full range of reasons for a child’s academic struggles, before determining the root causes. Using this approach in my many decades in practice, I have found that many children struggle academically due to specific, impaired cognitive functions, such as slow processing speed and impaired working memory.
Along the way I have continued my studies of cognitive and emotional development, in the domains of neuroscience, psychology and sociology. It was in this context that I came across a small but astonishing report in the July 11, 2005 Scientific American introducing Cogmed, a neuroscience program created by award-winning neuroscientist Dr. Torkel Klingberg and his team in Sweden. The report provided evidence that they had succeeded in creating a program that could actually change the power of a person’s key cognitive function: working memory. I had never before seen evidence of an intervention actually substantially altering a basic cognitive function, so I immediately contacted Cogmed to learn more. In 2006, after a few months of careful due diligence I was invited to Stockholm to meet the development team and see the program, which was at this point already in widespread use in Sweden.
During my visit, I learned that this was a very serious scientific effort. The team used the best possible knowledge available in neuroscience, and the most exquisite standards of experimentation to develop an intervention that actually changes a person’s working memory capacity. Impressed by the program’s scientific rigor, I returned to the United States as a certified Cogmed coach. I was the first US clinician to enroll a client and complete a full Cogmed training program. Over the next 17 years, I worked with many, many children struggling in school, as well as helped US military veterans with traumatic brain injuries to regain crucial working memory function. The results were extraordinary but not unnatural, which is to say: we saw almost exactly the level of improvement shown in the numerous peer-reviewed publications on Cogmed’s efficacy. Approximately 80% of the people who trained with Cogmed experienced significant enough improvements in their working memory to see real-life benefits. About half of the participants described these benefits to be quite dramatic.
In our practice, we saw student after student complete the Cogmed training and find that they could now better manage their lives. They got homework done with much less trouble, improved their school performance, decreased dawdling at home and reduced their issues with daily routines.
The majority of these children were on the road to being diagnosed with ADHD and prescribed amphetamines. But, all who experienced substantial improvements from Cogmed avoided the diagnosis and drugs. Most of them had undergone pediatric neuropsychological evaluations and demonstrated working memory deficits, making them good candidates for a program designed to improve this specific function. Ten to fifteen years later, I have spoken with these individuals, now adults, and learned that the impact of Cogmed has endured without further training.
Through our work with the US Veterans Association, we heard incredible stories of recovery after Cogmed training. One veteran, severely disabled by traumatic brain injury and isolated at home, could not pass a driver’s license test despite intensive therapies. It was only after completing Cogmed training that he regained enough mental clarity to resume normal daily activities, including writing checks and driving.
Back in 2005 I knew that Cogmed was approaching the American market - a market that is inundated with a Barnum and Bailey approach to selling worthless goods. Turning on the TV unleashes an immediate parade of people swearing that this or that pill restored their mental powers: a series of shams from a series of false products with no science behind them. So how do you approach a market flooded with false claims of being able to change the power to think? The Cogmed team had the answer I respect the most - they came to our market with the data, plain and powerful. They consistently maintain a commitment to only making claims that have been tested with rigorous scientific methods. They have never strayed from the specific data showing that Cogmed improves working memory, even going to the trouble of testing whether it alters other cognitive functions in order to be clear that the design is truly specific to working memory. I was also impressed to see fMRI studies of patterns of activation of working memory processes which actually show that more of the brain is engaged in working memory activity after training with Cogmed, compared to before. The Cogmed teams’ dedication to scientific integrity is commendable. We don’t see glitzy marketing ads promising everything, just carefully done studies and a commitment to ensuring this serious and powerful intervention is only available to licensed professionals certified to coach according to its strict design.
As I near retirement after over 40 years of training and professional practice, I can very honestly say that one of my proudest achievements has been collaborating with Cogmed—studying the work of the science team, helping to bring Cogmed to America, and training numerous children and veterans. Witnessing the significant improvements in the mental functioning of these individuals has been one of my greatest joys. The mind is central to everything we hope to accomplish, and it is extraordinary that we have developed the ability to improve its function through a program like Cogmed.
If you are interested in getting in touch with Arthur, you can find him via email at: alavinmd@gmail
Pediatrician, Cleveland, Ohio USA