1. MBHE Cognitive Training Breakout
• In-class = theory
• Tonight = best practice guidelines
Week 6 – Cognitive Training
PSYC E-1609 Mind, Brain, Health,
and Education (MBHE): The Sciences of
Development, Learning, and Well-being

2. Training vs Teaching

3. Training vs Coaching

4. Malleable Cognitive Skills
4
Implications?

5. CHC Model of Cognitive Strengths
• Comprehension (Gc)
• Long-term Retrieval (Glr)
• Visual-Spatial Thinking (Gv)
• Auditory Processing (Ga)
• Fluid Reasoning (Gf)
• Processing Speed (Gs)
• Short Term Memory (Gsm)
• Executive Function (EF)
• Delayed Recall (Glrd)
• Phonemic Awareness (PA)

6. Tonight
• Results
• Applications
• Caveats
• Methodology
• Extended video sample
• Future directions

7. Local Results

8. Bungelabs Results

9. Sternberg Conclusions
• “Fluid intelligence is trainable to a significant
and meaningful degree;
• Training is subject to dosage effects,
• more training leading to greater gains;
• The effect occurs across the spectrum of
abilities…
Sternberg, R. J. (2008). Increasing fluid
intelligence is possible after all. Proceedings of
the National Academy of Sciences, 105(19),
6791-6792.
9

10. Applications
Cognitive Training Targets the Underlying Causes of
• Dyslexia / RD / CAPD
• Target working memory, rapid naming, phonemic awareness
• ADHD-I and ADHD-c
• Target working memory, processing speed, executive function
• NVLD
• Target visual processing, reasoning, executive function
• Homework marathons NOS
• Target working memory, processing speed, executive function,
reading fluency
• Bright students who appear to hate school
• Leading to low self-esteem
• And family distress

11. Yet Cautions/Caveats Remain
• Numerous research opportunities
• Breakthroughs will continue
• Limited public/private funding
• Majority R&D funds directed to computer-based methodologies
• Or pharmaceuticals
• Without full MBHE considerations
• Family-centered Heartscope approach has significant
benefits, also limitations
• Challenges for lay parents/teachers to rapidly digest
• Not targeted to grades or test-score growth
• Resource intensive
• Limited commercial potential (currently operating as non-profit)
• thus challenging to operate at larger scale

12. ‘Complicated’…? Yes and No
• Brains are complicated, as are:
• kids’ personal health factors;
• teachers/classrooms,
• families,
• communities
• national/state/local policies
• some helpful; some perhaps misguided
• Development is dynamic;
• can be influenced
• preferably for well-being
• although sometimes towards unhealthy trajectory

13. An MBHE approach need not be
complicated…
• Understand factors underlying ‘dynamic’
• Learning is integrated
• Mind
• Brain
• Health
• Education
• Understand best evidence,
• Then take low hanging fruit 1st

14. Two Choices Facing Complexity
1. Follow a protocol
• Improving protocol with new research/application tools
2. Surrender to complexity

15. Surrender Options
• “It’s the schools’ job …
• “It’s the doctors’ job …
• “Is this covered by insurance?

16. Section 504 Inertia
• Certainly unfair not to provide accommodations to
deserving students in short term
• US law requires schools to provide ‘reasonable’
• Yet equally unfair to maintain for long term
• Accommodations which suffocate a student’s
• Autonomy
• Self-Efficacy
• Social comparisons
• Niemiec, C. P., Lynch, M. F., Vansteenkiste, M., Bernstein, J., Deci, E. L., & Ryan, R.
M. (2006). The antecedents and consequences of autonomous self-regulation for
college: A self-determination theory perspective on socialization. Journal of
Adolescence, 29(5), 761-775.
• NO research supporting long-term accommodations
• Yet continues common practice

17. In Other Words
• Short-term, uplifting accommodations
= Life-saver
• Long-term, growth-limiting accommodations
= Life-sentence
• In practice, short vs long-term impacts
rarely a topic at parent/ SIT team meetings

18. Surrender narratives
• “meds worked great for my friend’s son …
• “try a different med ….
• “sleep/growth side-effects are ‘worth it ….’
• “too many kids use meds as a crutch ….
• “all kids hate school ….
• “some kids wired differently ….
• “I turned out fine ….
• “smart in other ways ….
• “just plain lazy ….
• “teachers are incompetent ….
• “poor parenting ….

19. a priori Barriers
• Education innovation must be
• school-based
• ‘proven’ to ‘work’ raising test scores
• Computer-based innovations must provide
• widespread access
• minimal oversight requirements
• commercial potential
• Medication non-compliance
• (both in terms of starting, as well as
continuing over long term)
• must denote negligent parenting

20. Yet, while we wait for
Research ….. politics ….. technology
• Many students suffering
• undiagnosed
• under-diagnosed
• misdiagnosed
• struggles mis-attributed to flawed character
• Time marches on
• neurons that fire together, wire together
• children average 1200’ of new ‘wiring’ growth each day

21. Myth Inertia
• “Many scientists and most laypeople believe you are
only as smart as your genes allow…
“Such thinking is …
“extremely unfortunate for the individual…
“and a disaster for public policy…
“Fortunately, that point of view is wrong. Here is
how we know…”
• Nisbett, R. E. (2009). Intelligence and how to get it: Why schools and
cultures count. WW Norton & Company.

22. Cognitive Training Methodology
• Step 1 – Identify Appropriate Candidates
• Step 2 – Assess Impact of Cognitive Synergy vs Friction
• Step 3 – Assess Emotional Synergy
• Step 4 – Ground Rules for Students
• Step 5 – Ground Rules for Parents
• Step 6 – Ground Rules for Brain Coaches
• Step 7 – Motivation Management
• Step 8 – Program Oversight
• Step 9 – Progress Test

23. Step 1: Identify/screen candidates
Most common brain training candidates (one, often more of)
• Partial responders to in-school interventions
• Partial responders to medical monotherapy
• Students struggling for >1 semester
• And/or more than one subject area
• Homework exhaustion nearly always present
• Previously identified SLD
• ADHD (-i, -h, -c)
• Dyslexia / CAPD / RD
• NVLD

24. …Partial responders to in-school
interventions
• Challenge: grade inflation
• Challenge: parents’ challenged to navigate (often
without support) waves of data that can be
• misleading (report cards, many 504 assurances),
• intentionally omitted (FAPE) and/or
• overwhelming (IEP)
• Challenge: family awareness of threshold criteria for
investigating symptoms’ underlying cause(s)
• Discrepancy
• RTI
• Failure to meet minimums?
• vs failure to maintain optimal?

25. … Crisis vs Subclinical
• Early interventions
• limits initial emotional damage from spreading
• more effective
• less costly
• both short and especially long-term
• yet easiest to dismiss/surrender
• Challenge: majority of families in these categories
are exhausted

26. … Partial responders to medical
monotherapy
• Challenge: a pill is not a skill
• Yet widespread practice to use medical therapy to treat non-
medical obstacles
• Challenge: physicians’ legitimate resource constraints
• Challenge: physicians’ cynicism towards family vigilance
• Challenge: physicians’ prior snake-oil experiences
• Challenge: minimal track record of sustainable
professional practice models for non-insurance based
interventions, eg,
• mindfulness,
• art / music / pet therapy
• neurofeedback,
• parenting classes for ADHD-h aged <6

27. … Students’ school struggles NOS
Defined as more than 1 semester and/or
more than 1 subject
• Challenge: parents’ over-reliance on report-card
grades
• Challenge: parents’ ego investments in kids’
school/sports performance
• Challenge: parents’ and teachers over-reliance on
re-teaching at home
• Challenge: cultural inertia favoring youth sports
• Challenge: cultural inertia accepting teen rebellion
• distinction angry teen vs exhausted teen

28. Step 2: Assess cognitive synergy
Cognitive Synergy vs Cognitive Friction
• Recall Broad CHC Components of IQ
CrystallizedFluid

29. … Fluid Intelligence
Components
• Long-term Retrieval Glr
• Visual-Spatial Thinking Gv
• Auditory Processing Ga
• Fluid Reasoning Gf
• Processing Speed Gs
• Short Term Memory Gsm
• Executive Function
• Working Memory
• Phonemic Awareness
• Most accessible to
targeted
intervention
• Early intervention
preferred
• Gains available at
least through young
adulthood
• likely entire lifespan

30. … Crystallized Intelligence
Comprehension-Knowledge (Gc)
• ‘Best’ training is by
• Reading as a life-style
• “Reading changes your brain” (Wolf)
• Quantity of pages K-16, (ref Stanovich, The Matthew Effect)
• Breadth of vocabulary exposure
• Writing
• Verbal interaction
• Parents, peers, community

31. … Cognitive Synergy Example
Thus IQ +/- 120; SAT projected +/- 1700; 90th percentile

32. … Cognitive Friction Example
Also IQ 120 – with much higher SAT upside in optimal
conditions (yet optimal unlikely to attain)

33. Which Student Most Likely To Attain
Optimal Growth?
Friction = likely disruptive from age 5-6 on.
More likely medicated than assessed. High risk
anxiety-related disorder as teen/young-adult
Synergy = comfortable with
school; learning ‘history’
likely very positive year by
year. Less vulnerable to
below-average teacher.

34. Quiz: Synergy or Friction?
Hint: 100 IQ is exactly ‘normal’. This student is faster
than average and a decent (not stellar) reader.

35. A:(trickquestion): It Depends On…
• Are peers (social comparison) ‘average’ or ‘college prep’?
National
Average
College
Prep

36. … Because Ecology Matters
Must consider BOTH
• Personal friction/synergy, ie, “Intra-synergy”
• Classroom “Inter-synergy”
• (Often family ecology as well)

37. … The Curse of ‘Has The Ability…’
• Implied: ‘choosing not to use it.’
(therefore character failure also implied)
• No child likes (nor thrives) being judged as flawed
• especially by those he most loves and seeks the approval of
• Alternative Inquiry for parents/teachers:
is there a plausible cause for cognitive friction?
• Alternative: child-centered (vs curriculum-centered)
i,e, ‘seek first to understand’ students’
• fatigue/surrender
• vs inattention
• vs amotivation
• (Off the record, this is point when parents most likely in tears)

38. s3: Assess Emotional Synergy
• Eustress vs distress
• Homeostasis vs Allostasis
• “Without attending to [multisystem resiliency] interactions,
stress effects are often masked and missed.
• “Taking account of the cluster of positive buffering factors
that operate across the lifespan will take us a step further in
understanding healthy … aging broadly, from cellular to
systemic health.
• Puterman, E., & Epel, E. (2012). An Intricate Dance: Life Experience, Multisystem Resiliency,
and Rate of Telomere Decline Throughout the Lifespan. Social and personality psychology
compass, 6(11), 807-825.
• Also: Repetti, R. L., Robles, T. F., & Reynolds, B. (2011). Allostatic processes in the family.
Development and psychopathology, 23(3), 921-938.
• Ganzel, B. L., Morris, P. A., & Wethington, E. (2010). Allostasis and the human brain:
Integrating models of stress from the social and life sciences. Psychological review, 117(1),

39. … Physical Fatigue
vs Emotional Fatigue
• “… colleges now only admit
over-scheduled children...”
• Elaine Tuttle Hansen. Executive Director of the Johns
Hopkins Center for Talented Youth. 4/8/13 NPR

40. … Internal vs External
• Limbic (HPA) Activation
• Internal vs External Threat
• Actual or perceived
• Internalized vs Externalized Behavior
• Girls may tend to internalize self-judgments
• Are boys really 4x more vulnerable for ADHD?
• Or perhaps 4x more likely to externalize their frustration?
• Projected trajectory of misguided self-judgments

41. Steps 4+: Initiate Training
Guided By Assessment, Begin ‘Brain Workouts”:
• Ground Rules for Students
• Ground Rules for Parents
• Ground Rules for Brain Coaches
• Motivation Management
• Program Oversight and Adjustments
• Progress Test

42. s4: Ground Rules for Students
• Daily 3GT: Three Good Things
• Posture – breath – hands – feet
• Okay to make mistakes
• “I’ve failed over and over and over
again in my life ... and that is why
I succeed” Michael Jordan
• Effective response to mistakes is a learned skill
• Okay to feel (a little) frustrated
• Not okay to quit
• Effective response to small mistakes helps avoid big mistakes
• Benefits of positive self-talk
• “Whether you think you can, or you think you can’t, …..
you are probably right.”… Henry Ford
• ‘Ready to Work?’ is a binary question
• If yes, best efforts expected
• If no, reschedule for a better day

43. s5: Ground Rules For Parents
• Parents’ self-management of own stress
• Healthy body is healthy brain
• Esp ‘green time’
• Daily parent/child 1:1 attention
• Understand subtle impacts of performance praise:
• authentic vs
• contingent vs
• unconditional
• Dosage effect of training
• 5-6h average per week appears optimal
• Less likely significant growth < 3hr

44. … Parents…
• Homework cap at 15m per grade level
• Eg 6th grade cap is 90min
• Fun-reading doesn’t count against cap
• Engage positively with school allies
• Resist emotional response to resentment
• Navigate around school foes
• Encourage – don’t insist upon – Heartscope/teacher
collaboration

45. … Parents…
• If current/history of meds
• Suggest titrate to sleep
• Rule-out rare, but vexing, comorbidities
• History of sports concussions
• Sleep apnea, restless leg
• Vit D, anemia, TSH
• Infectious disease (Lyme, giardia, West Nile)
• Encourage parents/docs explore nuances of
AACAP vs AAP guidelines
• NOTE: We collaborate with willing docs, but NEVER
substitute our judgment for theirs
• Challenging/complex cases urged to seek a second opinion

46. s6: Ground Rules for Coaches
• Above all else,
• Emotional safety
• Nonjudgmental
• Authentic
• Praise/critique ‘process’
• Never ‘person’
(NOTE – Reasonable to expect ‘Do
whatever it takes’ parents to attain
60%+ coaching efficacy in 4-6w)

47. … Proximal Challenge
• ‘Training Zone’ (TZ)
• Ref Vygotsky, Csikszentmihalyi
• Respond to TZ changes
• Day by day
• Task by task
• As growth solidifies
• Or cognitive stamina declines under duress

48. … Cognitive Competition
• Simultaneous challenge
• 3 dimensions
• Layered Cognitive Targets
• Complexity
• Intensity

49. … Error Correction
• Immediate
• Nonjudgmental
• Better to model correct response than critique
• Evolve from coach-detect to student-detect

50. … Goal = Automaticity
Vs Classroom Paradigm of ‘Mastery’
• Automaticity likely reflects decreased PFC activation
• Precision essential
• Perils of ‘practicing it wrong’
• (technically or emotionally)
• Automaticity illustration:
• Say a driver is late and lost to an important appointment…
(ie, seeking visual/spatial orientation)
• Why, then, do most drivers need to turn off the radio?
(what does auditory input have to do with V/S processing?)

51. … Invest in Long-Term Goals
• Remember long-term target NOT GPA or test-score gain
• although low GPAs and test-scores almost always improve
• Rather, training goal is to target precursors
to long-term academic well-being
• Attention
• Efficiency
• Resilience
• Versus more common short-term response in
many schools (and some families) to work
AROUND, not ON,
weak cognitive skills

52. Video Training Example

53. s7: Motivation Management
• Remember primary student motivators (Bandura)
• Situational/Contextual
• Ecological
• Vicarious
• Historical
• “Persuasion” coaching methods
• Either positive or negative
• Are generally ineffective
• Yet most commonly used

54. … Handling Amotivation During
Training
• Short term student affect is irrelevant
• Ignore annoying, diversionary or attention seeking
behaviors
• “Tell me later, now let’s get back to work….”
• STOP training when behaviors interfere
• Default to empathy response - never presume malevolence
• Interview for daily stressors
• Re-assess ‘Ready to Work?’
• Binary options: Yes or No
• Limit/eliminate ‘Persuasion’ responses
• Coaches self-check own stress/fatigue levels

55. … Plausibly ZERO Cases in 24yr
Of genuinely amotivated students ages 3-21
• Without significant causes / comorbidities
• (granted hindsight offers clarity)
• Students’ personal MBHE factors
• School ecology
• Family ecology
• Some suggest Teen Motivation is Art, not Science?
• Or is ‘Art’ a surrender narrative for grownups
unfamiliar with motivation science?
• Especially relevant
• Bandura
• Dweck
• Deci/Ryan
• Zimmerman
• Ericsson (Anders)

56. Step 8: Program Oversight
• Regularly review presence of authentic ‘process’ praise
• As opposed to “He got an A on his spelling test,
Hooray! He’s not lazy!” (Client-Mom, 4/8/13)
• Optimize ‘TZ minutes per month’
• Rotate activities to maintain novelty
• 10-12 active from superset of 30
• Chart significant breakthrough moments
• School
• Home
• In-session

57. … Rebalance tasks to overweight
then-weakest skills
• Requires systematic review
• Daily
• Weekly
• Monthly
• Analyze plateaus
• Danger of ‘anti-training’
• Challenge of distinguishing events vs trends
• Thus succinct charting essential

58. … Progress test after 80 training hours
• Combined home, clinic, PC
• Note primary publishers don’t currently provide form A/B in
cognitive tests
• Debrief team after every progress test
• We’re committed
• But not perfect
• Human nature to be susceptible to attribution errors

59. … Check-in with student/family after
6-12 months
• Many ‘modest’ qualitative outcomes evolve
over time to ‘major’
• (not always correlated with quantitative growth)
• Yet some families forget school pain, recall
training burden
• Some families/schools continue to struggle with
comorbidities

60. … Coaches can expect serendipitous
encounters
With families/students showing exceptional
• Courage
• Commitment
• Love
• Openness to personal growth and new Learning

61. So, Which team dominates
the 4th quarter?

62. Future
Open-source brain training
• Bungelab games (*)
• (disclaimer no endorsement implied )
• Community contributions
• Improve teacher/specialist/physician awareness
• Role of cognitive skill strength
• To growth in authentic self-esteem
• Accessible all demographic groups
• Data collection / analysis
• Better forecast potential burdens of comorbidities
• Thus better prioritize evidence-based interventions

63. Study Dosage/Delivery Effects
• Confirm/refute contributions of
• limbic,
• parental,
• allostatic loads, etc.
• Optimal TZ minutes per week
• Optimal % TZ online
• Long-term:
• Confirm/refute developmental ceiling

64. Further Questions
• tom@kcbrain.org