Monday, April 25, 2011

Family: Memory, forget me not


If your memory seems to be failing you, all’s not lost, as INTAN MAIZURA AHMAD KAMAL discovers
I’VE come to a startling conclusion: My working memory sucks! I don’t know whether it’s age, or I'm not exercising enough, or that I’m simply juggling too many things at once, but really, it’s alarming how I'm forgetting the slightest things that I wouldn’t, say, two years ago.

Our working memory is literally our brain’s post-it note. It's one of the most important areas of our memory system as it's akin to our ability to hold and use a limited amount of information in our heads for a brief period. But the amount of information itself is unstable — a sudden distraction and the information is lost and you have to start all over again. These days, I keep colourful post-it notes on my dressing mirror, by my bedside and around the house. And just to be safe, I also use my poor kids to be my "working memory”.

Should I be alarmed? “It’s nothing to worry about," assures Dr Tracy Packiam Alloway, director of Centre For Memory And Learning In The Lifespan at University of Stirling, Britain, and author of over 75 scientific articles and books on working memory and learning. The bubbly 36-year-old was recently in town for a one-day workshop on working memory, organised by Kidzgrow, a one-stop centre that provides solutions for children with all types of learning difficulties.
“It’s similar to the ‘top of the stairs’ phenomenon,” she says with a smile. “You get to the top of the stairs and then you start wondering why you're even there in the first place. When you’re juggling too many things, you’re bound to drop one of the balls!” The average mother, adds the Malaysian-born Alloway who migrated to the United States when she was 13, probably has an average post-it note, but she would have filled it with so many details that things start to fall off the edge. And she ends up forgetting things and having a brain freeze. “All of us get this,” reiterates Alloway, who has also developed the world’s first standardised working memory tests for educators published by Pearson Assessment. “If you’re concerned that your memory is declining, the better index to check against is whether you can still recognise faces. As we get older, we have a harder time remembering faces, and that’s more of a concern than coming to the top of the stairs and wondering why you’re there!” To address this “malady”, the genial mother-of-two says we need to find that moment of peace or calm, whether through meditation, prayer or even listening to a song for five minutes. Prioritising is key here.

Alloway says: “If what you want to do doesn’t need to be done at that moment, leave it first. I’m a working mother and I make sure that if I have to attend to emails, I do it at one time of the day. If I have many things to do, I wake up early and budget my time. “I work when the kids are at the nursery. When they’re around, it’s shutdown time and I won't take calls or do emails so the children feel special and I don’t feel so torn having to think about things that need doing.” But what can we do to improve our working memory and keep our brain young? Alloway, who holds a PhD in cognitive psychology, says there’s exciting evidence of our brain’s plasticity, that it can change — shrink or grow — depending on what we do. One of the easiest ways to keep the pathway to our memory clear is to play games. “Pick up the newspaper and tell yourself that you’re going to circle 10 words starting with ‘M’ for example. The idea is to improve your visual scanning skill,” she suggests.

Exercise, too, can help the brain grow. A moderate workout may generate new brain cells, but not just any brain cell. These cells specifically help to distinguish between memories so each recollection stands out. It’s the kind of function you rely on every day, says Tim Bussey, one of the authors of the Cambridge University study.
Your diet is important as well. A diet rich in Omega fatty acids is instrumental in keeping your brain from ageing. “Foods rich in DHA, Omega-3 and 6 make the biggest difference,” says Alloway, an adviser to the World Bank on the importance of working memory. “The healthy fat molecules in your brain need to be flexible or wavy, and foods such as salmon, mackerel, avocado and olive oil help those fatty cells stay flexible, which, in turn, helps make your connection when you’re learning. “When you start eating foods that are bad for you, they end up making your fat cells more rigid, which makes it difficult for your brain to acquire knowledge.” Alloway, the 2009 winner of the prestigious Joseph Lister Award by the British Science Association for bringing her scientific discoveries to a wide audience, has been researching the area of working memory for the last 15 years. A boy called Josh got her interest piqued. She recalls: “I met Josh, this cute four-year-old living in California, because of a call for help from his distressed mum. Josh received funding from the state of California to support his learning needs. Because of that, he was regularly evaluated and assessed. “In one assessment, they found his IQ to be average for his age, but his working memory was very low. He was at the bottom end of the scale for his age. But because his IQ was average, the state decided that he didn’t need any financial support for his learning needs.” His mum, recalls Alloway, was thoroughly distraught at this turn of events and subsequently started looking up online on working memory. “That’s when she came across my research and got in touch. She asked whether I’d be willing to test Josh. I found he was very poor for his age when it came to working memory, so she decided to take her son's case forward to the Disability Tribunal, a legal proceeding for learning disability where the judge would look at the reports and make a decision. She asked if I would, via video link, testify on my research on working memory. I agreed.” But not long after, Alloway was informed that she didn’t have to testify in the case as the judge had ruled that because Josh’s working memory was so poor, even though his IQ was average, he needed the support. Understanding working memory can go a long way in helping us understand our kids, too. Parents who worry that their child is falling behind at school and have concluded that it’s due to laziness, should take note. Your kids may just have smaller post-it notes and they’ve run out of space, so they can't keep everything in their mind, says Alloway. “These kids are unable to remember everything the teacher says and work with the information at the same time. Looking solely at IQ as the benchmark for success is the wrong way to go. “One main distinction between IQ and working memory is that the former works with the knowledge that we have, the kind of experience that we have about the world, and the knowledge we’ve acquired. The latter relates to how we use that knowledge.” To spot a child with memory problem, use a standardised test, says Alloway. “With my colleagues from Durham University, we worked with a leading test publisher, Pearson Assessment, and developed a test battery, published in 2007.” The tool, a combination of a checklist and computer program informed by years of concentrated research into poor working memory in children, has enabled teachers to identify and assess children's memory capacity in the classroom from as early as four years old. Without appropriate intervention, poor working memory in children, which is thought to be genetic, can affect long-term academic success into adulthood and prevent children from achieving their potential, says Alloway.

She’s also working with Kidzgrow on a memory training program called Jungle Memory to help kids with small post-it notes. “I’ve had a chance to do my research with organisations such as Dyslexic Scotland and various autistic charities looking at kids with learning difficulties and those not achieving their potential and found that when children used this program, their working memory, IQ scores and most importantly, their grades improved in only eight weeks.

“People used to think that you can’t change your working memory. But you can, and there are many things you can do. There's definitely hope.”

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Thursday, April 21, 2011

Top Ten Tips for Parenting ADHD Kids

by Dr. Lara Honos-Webb

Published on December 8, 2010

1. Advocate for your child. This means you need to "spin" your child's behavior to friends, family and teachers. Has your child's antics been any worse than our leading politicians? Probably not. Imagine the spinmeisters on talk shows who try to get their politicians elected. Do the same for your child.

2. Coach your child to name and feel ok with all their emotions. Kids act bad when they are mad, sad or afraid. When you coach your child to tell you what she feels, her bad behavior will heal.

3. Look inside yourself. Sometimes kids act out unexpressed conflicts of their parents. Are you struggling with depression, anxiety, rage? Get help for yourself and your kids will shape up.

4. Think of yourself as a coach. Your job is to coach your child to success in social, emotional and educational settings. Sometimes the answer is practice, practice, practice. Don't get discouraged if you have to repeat yourself over and over again.

5. Ask yourself: "If my child's most frustrating behavior was meant to teach me something - what would it be?" Many parents find themselves half distressed and half impressed at their child's indifference to people pleasing. Sometimes this is just the lesson parents need to learn in their own lives - many parents have become imbalanced in attending too much to seeking approval from others.

6. Forget about the competition. Your child can still strive to be outstanding without it being about comparisons to other children. ADHD children are sensitive to tension produced by parents' competitiveness and the fear based motivation inhibits them.

7. Keep Yourself Alive! It takes a lot of energy to keep up with ADHD kids. You need to become your own energy source. Feed your own passions. If you are married work to increase your intimacy with your partner. If you are single, keep your own love life alive.

8. Honor the kernel of self-reliance in all acts of defiance. Every time your child doesn't do what you asked them to do, ask them for an explanation. Honor their independent thinking and consider what part of it you may want to incorporate into your discipline. Continue to insist that your child respect your rules while demonstrating respect for their own rhythm and logic.

9. Practice preventative medicine. Many times children's bad behavior is a misguided attempt to get some precious attention. Fuel your child up with the highest octane energy you can early in the day. Spend a few minutes being entirely present with your child. Look them in the eyes, touch them lovingly and listen closely to your child. This intense presence will give them what they need and head off desperate pleas for attention. Sometimes just a few minutes will prevent large energy draining hassles.

10. Connect with your child's teacher. Research has shown over many decades that your child's educational outcomes are very closely linked with how much the teacher  expects from your child. This is why you need to advocate for your child at the same time as you connect with your child's teacher. Show enormous respect for your child's teachers and try to forge a close alliance with him or her. They will go the extra mile for your child.

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ADHD and Medication: What's New?

by Tracy Packiam Alloway, PhD

To medicate or not? Research in children with ADHD.

Study: Diet May Help ADHD Kids More Than Drugs

by NPR Staff

March 12, 2011

Hyperactivity. Fidgeting. Inattention. Impulsivity. If your child has one or more of these qualities on a regular basis, you may be told that he or she has attention deficit hyperactivity disorder. If so, they'd be among about 10 percent of children in the United States.

Kids with ADHD can be restless and difficult to handle. Many of them are treated with drugs, but a new study says food may be the key. Published in The Lancet journal, the study suggests that with a very restrictive diet, kids with ADHD could experience a significant reduction in symptoms.

The study's lead author, Dr. Lidy Pelsser of the ADHD Research Centre in the Netherlands, writes in The Lancet that the disorder is triggered in many cases by external factors — and those can be treated through changes to one's environment.

"ADHD, it's just a couple of symptoms — it's not a disease," the Dutch researcher tells All Things Considered weekend host Guy Raz.

The way we think about — and treat — these behaviors is wrong, Pelsser says. "There is a paradigm shift needed. If a child is diagnosed ADHD, we should say, 'OK, we have got those symptoms, now let's start looking for a cause.' "

Pelsser compares ADHD to eczema. "The skin is affected, but a lot of people get eczema because of a latex allergy or because they are eating a pineapple or strawberries."

According to Pelsser, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food. Researchers determined that by starting kids on a very elaborate diet, then restricting it over a few weeks' time.

"It's only five weeks," Pelsser says. "If it is the diet, then we start to find out which foods are causing the problems."

Teachers and doctors who worked with children in the study reported marked changes in behavior. "In fact, they were flabbergasted," Pelsser says.

"After the diet, they were just normal children with normal behavior," she says. No longer were they easily distracted or forgetful, and the temper tantrums subsided.

Some teachers said they never thought it would work, Pelsser says. "It was so strange," she says, "that a diet would change the behavior of a child as thoroughly as they saw it. It was a miracle, a teacher said."

But diet is not the solution for all children with ADHD, Pelsser cautions.

"In all children, we should start with diet research," she says. If a child's behavior doesn't change, then drugs may still be necessary. "But now we are giving them all drugs, and I think that's a huge mistake," she says.

Also, Pelsser warns, altering your child's diet without a doctor's supervision is inadvisable.

"We have got good news — that food is the main cause of ADHD," she says. "We've got bad news — that we have to train physicians to monitor this procedure because it cannot be done by a physician who is not trained."

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FDA Holds Off On New Heart Warnings For ADHD Medicines

by Scott Hensley

Steady as you go on ADHD medicines.

The Food and Drug Administration has finally received data from a massive analysis of health records to tease out whether there is a link between normal use of ADHD medicines and potentially lethal heart problems. And, for now, the FDA says it's not recommending any changes in safety instruction or use of such popular meds as Vyvanse and Adderall.

The agency has been looking at a possible link between the drugs for attention deficit/hyperactivity disorder and sudden cardiac death in otherwise healthy people since 2009, when a federally funded study suggested there might be one.

The study that sparked concern compared ADHD drug use among 564 young people (ages 7 to 19) who died suddenly from unexplained causes with an identical number killed in car crashes. Ten of the young people who died suddenly were taking ADHD meds compared with just two in the group who died in accidents. Those results were published in the American Journal of Psychiatry.

The agency noted a bunch of limitations with the research at the time and told parents not to stop kids' ADHD meds. Still, the agency said it would look into the issue.

In search of a more definitive answer, the FDA and the federal Agency for Healthcare Research and Quality teamed up to sponsor a look at health data for more than 500,000 people taking ADHD meds and 1 million people who weren't. Analysts also planned to pore over about 2,000 medical charts from hundreds of different hospitals.

The work took a lot longer than expected. So the preliminary findings, originally due in late 2009, have finally rolled in. The FDA has started reviewing them and doesn't seem worried. In a brief update online, the agency said:

    At this time, FDA is not recommending any changes to the drug labels and/or the use of these medications.

    FDA will update the public after the results of the final analyses are evaluated.

The current instructions for ADHD drugs, which are stimulants, say that misusing them "may cause sudden death and serious cardiovascular adverse events."

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Wednesday, April 13, 2011

New Online Training For GPs - Identifying And Managing Autism Spectrum Disorders

Identifying and managing children with autism spectrum disorders (ASD) is the focus of a new online active learning module created by the Royal Australian College of General Practitioners (RACGP). 

The new Autism spectrum disorders Category 1 active learning module is available on the gplearning website and is suitable for GPs and paediatricians. Autism spectrum disorders highlights the importance of early identification and diagnosis, initiation of early intervention and family and individual support as a means of maximising outcomes for children and families affected by an ASD. 

Dr Ronald McCoy, RACGP spokesperson, said the rate of ASD diagnosis is increasing significantly within the Australian community and this new active learning module will provide GPs with timely and valuable insights into autism spectrum disorders. 

"The early diagnosis of autism spectrum disorder is the key to providing early intervention so that patients and their families can achieve the best outcomes, 

"For this reason, this learning activity places a strong emphasis on 'red flags', which are clinical symptoms and signs that help clinicians pick up autism early. 

"We've been incredibly fortunate in being able to achieve this through the creation of many new videos that plainly illustrate specific clinical symptoms and signs. This was only achievable through the generosity of families affected by ASD. 

"This module provides doctors with the skills to address the many myths that surround ASD, such as bogus causes and treatments that are widespread throughout the community. 

"In addition, case studies, interviews and actual clinical images provide a unique interactive learning opportunity for clinicians to become thoroughly acquainted with the current evidence based, state-of-the art approach to ASD in Australia," Dr McCoy said. 

By the end of the module, participants should be able to: 

- counsel and support patients, parents, family members and others affected by ASD, through diagnosis, treatment and ongoing management of ASD 
- discuss the evidence base for aetiology (study of causes) and management of ASD including medications, behavioural and educational interventions 
- describe the diagnosis, prognosis and management of ASD throughout key milestones and throughout a person's lifespan 
- discuss the multidisciplinary framework of care in ASD 
- identify barriers to delivering services for ASD e.g. rural location 
- identify individuals with possible ASD, including differential diagnoses 
- list the 'red flags' for ASD and be able to systematically implement identification of children with ASD, including using the practice systems. 

The new activity is supported by funding from the Australian Government Department of Health and Ageing and has been approved by the RACGP QI&CPD Program for 40 Category 1 points in the 2011-2013 triennium. 

This active learning module should take approximately 6.5 hours to complete. Participants can access and exit activities at their convenience. 

The following four learning activities are available as Category 2 activities but are included as part of this learning module: 

- the early detection of autism spectrum disorders (ASD) 
- selecting and assessing interventions for ASD 
- educational interventions for ASD 
- working with families managing ASD. 


Royal Australian College of General Practitioners (RACGP) 

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