Special Invited ReviewTraining the brain: Fact and fad in cognitive and behavioral remediation
Introduction
Increasingly ubiquitous, training programs foster the putative promise of enhancing or rehabilitating behavior and brain function. This trend comprises a burgeoning market of products alleged to enhance cognition, emotion, thought and action. Catering to individuals of all ages, but targeting young children and the elderly in particular, such programs claim to benefit healthy populations as well as those diagnosed with specific disorders. Many commercial programs take advantage of computerized training over the Internet, offering the comfort and privacy of home-based brain exercise. Appealing to a wide clientele – from the ambitious and healthy to the desperate and sick – brain training targets parents and professionals looking for an edge in a competitive society, symptom relief, or a potential cure.
Broadly defined, brain training refers to the engagement in a specific program or activity that aims to enhance a cognitive skill or general cognitive ability as a result of repetition over a circumscribed timeframe. Such training can produce changes measured at the behavioral as well as the neuroanatomical and functional levels. Many forms of brain training appear to improve cognitive function and emotional control, particularly programs that exercise attention (Rueda, Posner, and Rothbart, 2005). By practicing games or tasks that require choosing between two competing responses, the training of attention aims to strengthen the neural networks underlying control processes (Raz & Buhle, 2006). A strong modulator of cognition and affect, attention refers to the selective focus on specific aspects of our environment or to the concentration on specific mental thoughts and operations (Raz & Buhle, 2006). Similar to attention training (AT), many programs target working memory (WM), a system that mediates temporary information storage, modification, and protection from interference (Bledowski, Kaiser, & Rahm, 2010). Apart from attention and WM, studies suggest that practicing sustained attention through meditation (Tang & Posner, 2009), schooling (Diamond, Barnett, Thomas, & Munro, 2007), interaction with nature (Kaplan, 1995a), exercise (Kubesch et al., 2009), and musical training (Kraus & Chandrasekaran, 2010) can also improve cognitive ability and emotional control. The effects of such varied methods on cognitive ability and emotional stability attest to the advantages of specific exercises.
Brain training is especially relevant for developmental psychopathology. This approach has potential to ameliorate undesired symptoms of disorders such as attention deficit hyperactivity disorder (ADHD), a condition characterized by deficits in behavioral inhibition associated with cognitive processes that mediate goal-directed behaviors (Barkley, 1997). ADHD comprises a useful lens through which researchers examine the effects of training. A spectrum disorder, ADHD contains various degrees of severity that inflict mild to severe impairments, many of which relate to executive attention and may improve as a result of training (Illes & Sahakian, 2011). Currently, primary treatments for developmental psychopathologies such as ADHD often involve psychotropic medications, which sometimes show marginal effects. Even these effects, however, attenuate over time and can generate a number of unwanted side-effects. As a result, parents and clinicians are often reluctant to embrace drug-based therapy despite the scarcity of safe and effective treatment alternatives. Recent allegations add controversy to this dilemma by claiming that certain psychiatrists may have surreptitious ties with drug companies, biasing the research surrounding the production and distribution of medication for youth (“Credibility Crisis in Pediatric Psychiatry,” 2008). In light of such limitations in pharmacological-based remedies, brain training may represent an attractive adjunct to common pharmacological treatment.
The generalizability of brain training represents one of the major claims-to-fame of publicly distributed programs. With scarce data to support advertised claims, however, patrons of brain training often invest considerable resources pursuing programs that promote unsupported, arguably unrealistic, outcomes. While studies of computerized AT and working memory training (WMT) show, perhaps unsurprisingly, that trainees can improve significantly on cognitive skills related to the intervention (Westerberg et al., 2007), at least some findings suggest that training may generalize beyond task-specific skills and apply to untrained overarching abilities (Jaeggi et al., 2008, Jaeggi et al., 2010). Reported improvements sometimes extend to increased fluid intelligence, which refers to the ability to solve problems in novel situations (Buschkuehl and Jaeggi, 2010, Mackey et al., 2010). Such transfer effects may result from overlapping neural networks in the prefrontal cortex (PFC), which underlie both WM and fluid intelligence (Gray et al., 2003, Klingberg, 2010). Claims regarding the transfer of practiced skills to other untrained cognitive domains are contentious, however, because the appearance of transfer may, in fact, result from training-to-task (Snyder, 2011). Specifically, training programs may obliquely tax the very abilities that researchers subsequently test (Diamond, 2011). In addition, being the wild west of neuropsychology, many studies report experimental results using inadequate controls, if any (Papp, Walsh, & Snyder, 2009). Rather than generalizability, therefore, the improvements observed throughout various programs may arise due to reasons such as training-to-task.
Apparent from adequately controlled studies, brain training is a groundbreaking approach with potential to transform the panorama of non-pharmacological therapy. Despite the mounting prevalence of such products, the immense potential of such interventions for various populations, and the increasing evidence both supporting and disclaiming the effectiveness of training, no other article, to our knowledge, has thoroughly amalgamated the evidence surrounding cognitive programs and the populations that may benefit from training. In the present article, we critically evaluate the validity of claims regarding various brain exercises and cognitive remediation approaches. In an attempt to elucidate the effectiveness of brain training, we examine the impact of these programs in both healthy developing individuals and pathological populations. We further investigate the potential use of such training as an adjunct – or possible substitute – to current drug-based therapies for children with psychopathologies. We conclude by discussing specific conflicts that may hinder the advancement of research in this field and outline plausible outcomes of brain training with regards to factors that may alleviate or aggravate undesirable childhood behavior.
Section snippets
Neural and behavioral basis of brain training
Attention plays a central role in social behavior and academic performance. Due to brain plasticity, training can alter the neural correlates of attention and improve attentional control. In this section, we focus on a current, widely recognized model that subdivides attention into three separate systems. We discuss the function of these systems as well as their related neural networks, and delineate how these systems control behavior throughout development. Ultimately, we underline why
Origins and evolution of brain training
Whereas various cultural practices have influenced states of attention for centuries, the implications of altered mental states on cognitive function were sparsely documented before the late 20th century (Jevning, Wallace, & Beidebach, 1992). Studies in the 1960s and 1970s on relaxation therapy and early forms of AT were among the first research efforts leading to modern behavioral modification paradigms (Douglas et al., 1976, Paul, 1969, Pressley, 1979). This era of research witnessed
Culture, lifestyle, and brain training practices
Brain training has significantly impacted mainstream society. From claims of improving the negative symptoms of psychopathologies and neurological impairments to assertions of significantly boosting cognitive skills among the healthy, commercialized software and interactive programs are increasingly capturing the interest of parents, educators, students, and clinicians (see Table 1, Table 2). Tutoring services (e.g., (Kumon North America, 2011, Sylvan Learning, 2011)) entice parents looking to
The effectiveness of training practices: examining the evidence
In this section, we provide a critical examination of the impact of cognitive training in both healthy and pathological individuals. We investigate the generalizability of training and whether specific exercise can transfer to other domains of cognitive function.
Who can benefit from brain training?
Brain training programs may impact an assortment of neurological states. From the healthy to the neurologically impaired, programs aim to enhance or rehabilitate cognitive function in both young and old. In this section, we examine evidence for the benefits of brain training programs in various populations.
The business of brain training and conflicts of interest
Brain training constitutes a lucrative market. Widespread concern regarding cognitive decline in the aging population and obsession with maximizing efficiency in school and at work have created a society of brain trainers that spare little expense on cognitive fitness. With individual programs costing hundreds to thousands of dollars, this industry feeds on growing consumer interest to yield enormous profit. In 2010, the Scientific Learning Corporation – developer of programs such as FFW –
Conclusion
Brain training draws on both evidence and hype. Examination of the findings reveals that consumers – largely oversold on individualized modules and programs (e.g., for ADHD) – often rely on claims that are scientifically unsubstantiated. For these programs to be clinically useful, they will have to accomplish what few interventions, if any, have achieved: generalize circumscribed laboratory and computer skills to tangible gains in the classroom, during play, and in other ecological settings.
Acknowledgments
We would like to thank Rose Golinksi and members of the Raz Lab for providing helpful comments on earlier versions of this manuscript. In addition, Drs. Stephen Hinshaw, Deborah Leong, and Kimberly Kerns provided important insights regarding content and organization. Dr. Raz acknowledges the kind support of the Canada Research Chair program, the Canadian Institutes of Health Research, and the Natural Sciences and Engineering Research Council of Canada.
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