What is Cognitive Training (CT)

Cognitive Training (CT) works on the premise that cognitive abilities can be maintained or improved by exercising the brain, in a way similar to fitness routines/exercising improving physical fitness. CT uses intense mental exercises to target and work on the brain’s core cognitive skills.

By the time an individual reaches adulthood they have learned facts about how the world works. They have an understanding of right from wrong, for instance, that you can’t walk through walls or leap onto the tops of trees. They have developed abstract thought- where in even when they cannot see their car keys they know it is around here somewhere. They can communicate effectively – they know that if they want to communicate complex ideas like ordering a triple-scoop coffee, chocolate, vanilla ice-cream with chocolate sprinkles it is better to use words with meanings attached to them rather than simply gesturing and grunting. Human beings accumulate all this useful knowledge through the process of cognitive development, which involves a multitude of factors, both inherent and learned.

 Cognitive development is the field of study in neuroscience and psychology focusing on a child’s development in terms of information processing, conceptual resources, perceptual skill, language learning, and other aspects of brain development and cognitive psychology. Many children struggle with thinking, learning, reading, memory, and attention which are caused by weak cognitive skills. CT focuses on enhancing cognitive development in areas of deficits which we as human beings otherwise take for granted.

What does CT involve?

Cognition is a complex process. To elucidate – most reading struggles are due to a weakness in auditory processing. This is the cognitive skill that helps us identify, segment, and blend sounds. But other weak cognitive skills can interfere and exacerbate the difficulty with reading. For example, poor attention skills can mean a reader is frequently distracted, poor memory skills can interfere with recall, and poor visual processing skills can keep a reader from creating the mental pictures that help them comprehend and engage with what they just read.

In recent years, it has become evident that our brains can keep adapting and developing new abilities throughout our lifetime. This ability to reorganize and create new pathways is referred to as neuroplasticity, and it is the science behind cognitive training. CT as a tool is utilized by therapists and healthcare professionals to supplement and help enhance their therapeutic interactions with their clients. Research has shown that systematic brain training with the help of a cognitive developmental specialist can potentially result in the improvement of a number of cognitive skills including attention, working memory, problem solving abilities, reading and, in some cases, psychosocial functioning.

Cognitive skills are the core skills your brain uses to think, read, learn, remember, reason, and pay attention. Below is a brief description of each cognitive skill, as well as struggles that an individual may be experiencing when they have deficits in those concerned areas of the brain:

Attention/Sustained
What it does: Essential to stay focused on a given task and over sustained periods of time, depending on the nature of the task.
Common problems: Incomplete work, unfinished projects, jumping or oscillating from task to task

Attention/Selective
What it does: Essential to stay focused on the given task despite other visual/auditory distractions
Common problems: Easily distracted, unable to complete tasks

Attention/Divided
What it does: Essential to hold onto and remember information while completing two tasks at the same time
Common problems: unable to process auditory information when focusing on a visual task (eg. – responding to name when completing a puzzle), frequent mistakes

Memory/Long-Term
What it does: Essential in recalling information stored in the past through rehearsal or episodic memories
Common problems: Forgetting names, doing poorly on tests, forgetting things that they once knew

Memory/Working
What it does: Essential to hold on to information temporarily while in the process of using it for other work.
Common problems: mental math, having to read the directions again in the middle of a game, difficulty following multi-step directions, forgetting what was just said in a conversation

Logic & Reasoning
What it does: Essential to reasoning, forming ideas, and solving problems
Common problems: Frequently asking “What do I do next?” or saying “I don’t understand this,” struggling with math, feeling stuck or overwhelmed, anxious when faced with two or more situations

Auditory Processing
What it does: Essential to analyzing, blending, and segmenting sounds
Common problems: Reduced phonemic awareness, struggling with learning to read, reading fluency, or reading comprehension

Visual Processing
What it does: Essential to thinking using visual images and to make sense of the visual world
Common problems: Difficulties understanding what was just read, remembering what they have read, following directions, reading maps, doing word problems in math

Processing Speed
What it does: Essential to performing tasks quickly and accurately
Common problems: Most tasks are difficult, taking a long time to complete tasks for school or work, frequently being the last one in a group to finish or respond to something 

How does CT help?

Understanding how children think and learn has proven useful for improving education. One example comes from the area of reading. Cognitive developmental research has shown that phonemic awareness—that is, awareness of the component sounds within words—is a crucial skill in learning to read. To measure awareness of the component sounds within words, researchers ask children to decide whether two words rhyme, to decide whether the words start with the same sound, to identify the component sounds within words, and to indicate what would be left if a given sound were removed from a word.

Cognitive developmental research carried out by Ramani and Siegler (2008) hypothesized that distinctiveness in mathematical abilities is due to the children in middle- and upper-income families engaging more frequently in numerical activities, for example playing numerical board games such as snakes and ladders or pallankuzhi. Playing these games seemed likely to teach children about numbers, because in it, larger numbers are associated with greater values on a variety of dimensions. These spatial, kinesthetic, verbal, and time-based cues provide a broad-based, multisensory foundation for knowledge of numerical magnitudes (the sizes of numbers), a type of knowledge that is closely related to improvements in mathematics test scores (Booth & Siegler, 2006).

It is commonly assumed that intelligence is a fixed characteristic that you are simply born with. On the contrary, it is the various components of cognition that actually make up our brains capacity to function appropriately. Since CT works on improving various brain functioning, almost any specific activity involving novelty, variety, and challenge stimulates the brain and can contribute to building capacity and brain reserve. For instance, learning how to play the piano activates a number of brain functions (attention, memory, motor skills, etc.), which triggers changes in the underlying neuronal networks. The rationale and need for CT versus activities like learning the piano is that CT focusses on specific areas of deficit. The efficacy of CT is because the training effects “transfer” to benefits in daily life.

Who does CT help?

Management of cognitive deficits in children is quite challenging since the plasticity of a growing brain is different from that of an adult brain in several aspects. The conditions leading to cognitive deficits in children are heterogeneous with respect to the etiology, pathology and pathogenesis. Environmental factors have a significant impact on normal (Neuro-typical) or deviant (Neuro-atypical) development of the brain.

Cognitive deficits in children may be global as in the case of mental retardation, or specific as in learning disabilities, autism, developmental language disorders, anoxic brain damage, stroke, post infectious syndrome, and post traumatic and post demyelinating conditions. Cognitive deficits have also been observed in psychiatric and psychological disorders such as childhood schizophrenia and behavioural disorders. While the majority of these disorders are developmental in nature with a strong genetic basis, there are several acquired causes also for these disorders.

CT can help anyone and can be used for all ages. The focus at DIRECT is to use this modality of therapy to help children who have deficits in key cognitive skills that are critical for learning and/or development.

Attention Skills: A child’s ability to attend to incoming information can be observed, broken down into a variety of sub-skills, and improved through properly coordinated training. We train and strengthen the three primary types of attention:

Sustained Attention: The ability to remain focused and on task, and the amount of time we can focus.

Selective Attention: The ability to remain focused and on task while being subjected to related and unrelated sensory input (distractions).

Divided Attention: The ability to remember information while performing a mental operation and attending to two things at once (multi-tasking).

Memory: The ability to store and recall information.

Long-Term Memory: The ability to recall information that was stored in the past. Long-term memory is critical for spelling, recalling facts on tests, and comprehension. Weak long-term memory skills create symptoms like forgetting names and phone numbers, and doing poorly on unit tests.

Short-Term / Working Memory: The ability to apprehend and hold information in immediate awareness while simultaneously performing a mental operation. Children with short-term memory problems may need to look several times at something before copying, have problems following multi-step instructions, or need to have information repeated often.

Logic and Reasoning: The ability to reason, form concepts, and solve problems using unfamiliar information or novel procedures. Deductive reasoning extends this problem-solving ability to draw conclusions and come up with solutions by analyzing the relationships between given conditions. Students with underdeveloped logic and reasoning skills will generally struggle with word math problems and other abstract learning challenges. Children with deficits in these areas often perform poorly in math, lack self-direction and get flustered in real-life problem solving situations. 

Auditory Processing: The ability to analyze, blend, and segment sounds. Auditory processing is a crucial underlying skill for reading and spelling success, and is the number one skill needed for learning to read. Weakness in any of the auditory processing skills will greatly hinder learning to read, reading fluency, and comprehension. Children with auditory processing weakness also typically lose motivation to read. 

Visual Processing: The ability to perceive, analyze, and think in visual images. This includes visualization, which is the ability to create a picture in your mind of words or concepts. Children who have problems with visual processing may have difficulty following instructions, reading maps, doing word math problems, and comprehending. 

Processing Speed: The ability to perform simple or complex cognitive tasks quickly. This skill also measures the ability of the brain to work quickly and accurately while ignoring distracting stimuli. Slow processing speed makes every task more difficult. Very often, slow processing is one root of attention deficit type behaviours. Symptoms of weaknesses here include – unable to plan and keep time, homework taking a long time, always being the last one to get his or her shoes on, or being slow at completing even simple tasks.

CT at DIRECT

DIRECT clients of all ages work one-on-one with personal therapists for an hour long session, either 2 or 3 times a week (or longer, depending on the program), doing intense, fun mental exercises that work on the pathways the brain utilises to think, learn, read, and remember.

The face-to-face nature of the training relationship allows therapists to do three critical things:

1. focus on rigour by challenging clients to recognize, regulate and perform to their potential, learning to see failure not as frustrating, but as a motivator to achieve better results. Therapists encourage struggling children to engage, accept challenges, recognize improvements, and celebrate success.
2. focus on results by customizing each training session and encouraging clients to work past their comfort levels.
3. focus on evidence based practice and documentation through reading and professional development on current best practices around the world. Diligent documentation practices help record the progress of the child and collect factual data on their development.

CT at DIRECT works on each of the deficits to bring about a holistic change to difficulties. The training program is individualized to the cognitive developmental needs of the client and is goal specific. The activities are personalized and motivating. The training is carefully planned to gradually increase in difficulty, as the brain has the ability to reach a plateau/become bored and start to automatize the process. Hence all CT tasks are kept challenging for the client.