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Cognitive Educational Therapy

Improve Executive Functioning to Improve Learning

In only 12 weeks, Cognitive Educational Therapy (a unique program developed at Total Learning Centers) improves four areas of the brain's "executive functioning" necessary for learning: focus, working memory, phonological processing, and processing speed, and on the way improves confidence, self-esteem and interest in learning. Cognitive Educational Therapy applies the most recent research for improved functioning in school, home, social, and work environments.

When students struggle to learn in spite of at least average intelligence and adequate teaching, there are probably one or more connections in the brain that can be significantly strengthened. We say “probably” but current brain research related to brain plasticity shows that nearly everyone at any age has the potential to develop stronger and faster brain connections. The result of improving those neural connections is more efficient processing, which in turn allows for dramatically increased learning potential.

Before starting the program, each student is evaluated to find out what specific areas need strengthening and which parts of the program can be skipped or at least minimized. Each student then works through individualized exercises based on what they need to work on as illuminated through that preliminary testing.

Each aspect of the program is based on solid research (for example that improving working memory results in improved learning). Because it is research based, parents can have confidence that the individual parts of the program are inspired by proven methods. That is what we mean when we use the term “research based,” that each part of the program is based on research which has indicated that working on focus, memory, phonological processing, and processing speed does indeed improve those skills and therefore learning.

This is good, but we also must insist that the program as a whole, not just the individual parts, does what it says it does. So, from the start of the program, we have performed extensive pre and post testing to compare how each student performed before and after the program. We used nationally normed standardized test instruments. We continue to discover statistically what we are told by students and parents, that Cognitive Educational Therapy leads to substantial improvement in learning.

Though looked at both in terms of individual components and as a whole the program is clearly effective, of course no program can be 100% successful for every individual participant. The following are examples of variables which from time to time have negatively affected the level of impact the program has had on individual students. Though these examples do not necessarily affect progress, they can.

• Excessive absences from the program due to illness, vacations, conflicting extracurricular activities and appointments.
• Changes in medication during the program, such as trying to determine the optimum dosage and timing of medication for attention deficit hyperactivity disorder.
• Major family stresses such as divorce, death, or relocation.
• Heightened sustained anxiety over social or medical issues in or out of school.
• Very student-specific issues. For example, we had one student who showed definite progress throughout the program but was very tired on the day of post-testing which lead to lack of motivation and not performing at the much-improved level we had grown accustomed to seeing. Even though re-testing when he was more “awake” (as he put it) resulted in much higher post-test scores, it is an example of how an individual’s unique attributes contribute to outcome.

Thomas Brown, Ph.D., Assistant Clinical Professor of Psychiatry at the Yale University School of Medicine and Associate Director of the Yale Clinic for Attention and Related Disorders, stated, “A person's ability to perform the complex, self-managed tasks of everyday life provides a much better measure of his or her executive functioning than can neuropsychological tests.” ("Executive Functions and Attention Deficit Hyperactivity Disorder", International Journal of Disability, Development and Education, Vol. 53, No. 1.) Still, research is needed as well and so a sampling of research is included after a brief overview of each of the four areas are described below.

Focus

Using carefully planned exercises, students learn what it feels like to focus on first one item while ignoring all the other classroom background noises and then two and so on. After training, students are able to more easily pay attention to the teacher even within a typically busy classroom environment. With practice, their sustained attention, divided attention, and other aspects of focus increases. This really comes in handy for listening and taking notes from less-than-interesting lectures!

Research is plentiful backing up the idea of training attention to improve it. This includes both the two methods covered by Cognitive Educational Therapy - direct training as well as mindfulness. For example, just a few years ago, a study led by Antoine Lutz at UW-Madison, involved having subjects use meditation to improve attention. Results (published in the Journal of Neuroscience) suggested that attention stability is not fixed and permanent, that it can be improved by mental training, such as meditation.

Other research related to the efficacy of mindfulness and other attention training plus how attention training affects executive functioning includes:

Flook L., Smalley S.L., Kitil, M.J., Galla, B., Kaiser-Greenland, S., Locke, J., Kretzmann M., Ishijima, E., Kasari, C (2010). Mindful Awareness Practices Improve Executive Function in Elementary School Children. Journal of Applied School Psychology, Vol. 26, No. 1, 70-95.

Jha, A.P., Stanley, Elizabeth A., Kiyonaga, A., Wong, L., Gelfand, L (2010). Examining the Protective Effects of Mindfulness Training on Working Memory Capacity and Affective Experience of Emotion. Emotion, Vol. 10, No. 1, 54–64

Kerns, K. A., Eso, K., & Thompson, J. (1999). Investigation of a direct intervention for improving attention in young children with ADHD. Developmental Neuropsychology, 16, 273-295.

Singh, N. N., Singh, A. N., Lancioni, G. E., et al. (2010). Mindfulness training for parents and their children with ADHD increases the children’s compliance. Journal of Child and Family Studies, Vol. 19, No. 2, 15.

Sohlberg, M. M., & Mateer, C. A. (1987). Effectiveness of an attention- training program. Journal of Clinical and Experimental Neuropsychology, 9, 117-130.

Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention–deficit/hyperactivity disorder: A meta–analytic review. Biological Psychiatry, 57, 1336–1346.

Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. I., Hale, S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of Attention Disorders, 11(6), 737-746.

Dowsett, S. M., & Livesey, D. J. (2000). The development of inhibitory control in preschool children: effects of "executive skills" training. Developmental Psychobiology, 36(2), 161-174.

Fan, J., McCandliss, B. D., Sommer, T., Raz, A., & Posner, M. I. (2002). Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience, 14(3), 340-347.

Gray, J. M., & Robertson, I. H. (1989). Remediation of attentional difficulties following brain injury: Three experimental single case studies. Brain Injury, 3, 163-170.

Kerns, K. A., Eso, K., & Thompson, J. (1999). Investigation of a direct intervention for improving attention in young children with ADHD. Developmental Neuropsychology, 16, 273-295.

Rumbaugh, D. M., & Washburn, D. A. (1995). Attention and memory in relation to learning: A comparative adaptation perspective. In G. R. L. N. A. Krasnegor (Ed.), Attention, memory and executive function (pp. 199-219). Baltimore, MD: Brookes.

Sohlberg, M. M., & Mateer, C. A. (1987). Effectiveness of an attention-training program. Journal of Clinical Experimental Neuropsychology, 9(2), 117-130.

Thomson, J. B., Seidenstrang, L., Kerns, K. A., Sohlberg, M. M., & Mateer, C. A. (1984). Pay Attention! Puyallup, WA: Asssociation for Neuropyschological Research and Development.

Williams, D. J. (1989). A process-specific training program in the treatment of attention deficits in children., University of Washington, Seattle.

Working Memory

Working memory is considered by many to be the most critical key to school success. We all understand that the better a student’s memory, the easier it is to learn. In Cognitive Educational Therapy, students practice many techniques to help support memory. Using well-researched memory strategies such as chunking, telling a story related to the material being learned, and learning how to visualize help students remember and learn bits of information and lists in the school, home, and community.

Surprisingly, many students only have one way to remember – repetition. While repetition is useful, there are other ways to help support working memory. Memory tips and tricks are important tools, but nothing beats actually strengthening memory itself. So, students also systematically practice, and thus improve, the skill of remembering.

On the surface, working memory appears to be a very specific isolated ability. So, why put so much emphasis on improving it? It turns out children with weak working memory often have many other issues related to learning. In a study published in Child Development in 2009, researchers screened 3,189 five- to eleven-year-olds and found 308 to have very low working memory scores. Most struggled with learning, had atypically short attention spans, high levels of distractibility, difficulties monitoring the quality of their work and in generating new solutions to problems. This helps explain why we see so many students improve in multiple areas of learning after improving working memory.

The following is a sampling of research related to the importance of improving working memory:
Alloway, T. P., Gathercole, S. E., &Adams, A. (2005).Working memory and phonological awareness as predictors of progress towards early learning goals at school entry. British Journal of Developmental Psychology, 23, 417–426.

Gathercole, S. E., Pickering, S. J., Knight, C., & Stegmann, Z. (2004).Working memory skills and educational attainment: Evidence from national curriculum assessment at 7 and 14 years of age. Applied Cognitive Psychology, 18, 1–16.

Jaeggi, S.M., Buschkuel, M., Jonides, J., & Perrig, W.J. (2008). Improving fluid intelligence with training on working memory. Proceedings of the National Academy of Sciences of the United States of America, 105, 6829–6833.

Klingberg, T., Forssberg, H., & Westerberg, H. (2002). Training of working memory in children with ADHD. Journal of Clinical and Experimental Neuropsychology, 24, 781-791.

Olesen, P. J., Westerberg, H., & Klingberg, T. (2004). Increased prefrontal and parietal activity after training of working memory. Nature Neuroscience, 7(1), 75-79.

Turley-Ames, K., & Whitfield, M.M. (2003). Strategy training and working memory task performance. Journal of Memory and Language, 49, 446–468.

Westerberg, H., & Klingberg, T. (2007). Changes in cortical activity after training of working memory: a single-subject analysis. Physiology and Behavior, 92, 186–192.

Phonological Processing

Research indicates that students with phonological deficits will typically have more trouble learning to read and especially mastering the phonics required for fluid reading. Phonological processing is an auditory skill. It relates to words, but occurs in the process of hearing, with or without an accompanying printed word. It involves detecting and discriminating differences in phonemes, or speech sounds, under conditions of little or no distraction or distortion.
A student with phonological processing needs may have difficulty in one of many different tasks involving speech sounds in words. In school, the student often has difficulty associating speech sounds to letters when reading and spelling.
Students with poor phonological processing may:

• have difficulty with preschool and kindergarten skills needed for reading
• experience challenges sounding out words as they read
• substitute words with the same initial letter
• appear to use their own invented spelling which may continue past 1st grade

In a review of phonemic awareness research, Stanovich (1986) concluded that phonemic awareness is a better predictor of reading achievement than nonverbal intelligence, vocabulary, and listening comprehension, and that it often correlates more highly with learning to read than general intelligence or even reading readiness. It is fortunate therefore that research is clear that phonemic awareness training is possible and can result in significant gains in reading and spelling achievement (Ball & Blachman, 1991; Bradley & Bryant, 1983; Cunningham, 1990; Lundberg et al., 1988). In fact, research co-authored by Michael Merzenich showed not only did training in phonological processing improve reading but also functional MRIs showed actual changes in the brain as a result (“Neural deficits in children with dyslexia ameliorated by behavioral remediation: Evidence from functional MRI”).

The following is a sampling of research on how improving phonological processing affects learning:
Ball, E.W., & Blachman, B.A. (1991). Does phoneme segmentation training in kindergarten make a difference in early word recognition and developmental spelling? Reading Research Quarterly, 26, 49-66.

Blachman, B.A. (1991) Getting ready to read: Learning how print maps to speech. In J.F. Kavanagh (Ed.), The language continuum: From infancy to literacy (pp. 41-62). Timonium, MD: York Press.
Blachman, B.A., Ball, E.W., Black, R.S., & Tangel, D.M. (1994) Kindergarten teachers develop phoneme awareness in low-income, inner-city classrooms: Does it make a difference? Reading and Wrigin, 6, 1-18.

Bradley, L. & Bryant, P.E. (1983). Categorizing sounds and learning to read: A causal connection. Nature, 301, 419-421.

Byrne, B., & Fielding-Barnsley, R. (1991). Evaluation of a program to teach phonemic awareness to young children. Jounral of Educational Psychology, 83, 451-455.

Byrne, B., & Fielding-Barnsley, R. (1993). Evaluation of a program to teach phonemic awareness to young children: A 1-year follow-up. Journal of Educational Psychology, 85, 104-111.

Byrne, B., & Fielding-Barnsley, R. (1995). Evaluation of a program to teach phonemic awareness to young children: A 2- and 3-year follow-up and a new preschool trial. Journal of Educational Psychology, 87, 488-503.

Byrne, B., & Ledez, J. (1983). Phonolgical awareness in reading disabled adults. Australian Journal of Psychology, 35, 185-197.

Calfee, R.C., Lindamood, P.E., & Lindamood, C.H. (1973). Acoustic-phonetic skills and reading: Kindergarten through 12th grade. Journal of Educational Psychology, 64, 293-298.

Cardaso-Martins, C. (1995). Sensitivity to rhymes, syllables, and phonemes in literacy acquisition in Portuguese. Reading Research Quarterly, 30, 808-828.

Castle, J.M., Riach, J., & Nichsolson, T. (1994). Getting off to a better start in reading and spelling: The effects of phonemic awareness instruction within a whole-language program. Journal of Educational Psychology, 86, 350-359.

Cossu, G., Shankweiler, D., Liberman, I.Y., Tola, G., & Katz, L. (1998). Awareness of phonolgical segments and reading ability in Italian children. Applied Psycholinguistics, 9, 1-16.

Cunningham, A.E. (1990). Explicit versus implicit instruciton in phonemic awareness. Journal of Experimental Child Psychology, 50, 429-444.

Foorman, B.R., Francis, D.J., Beeler, T., Winikates, D., & Fletcher, J.M. (1997). Early interventions for children with reading problems: Study designs and preliminary findings. Learning Disabilities: A Multidisciplinary Journal, 8, 63-71.

Foorman, B.R., Francis, D.J., Fletcher, J.M., Winikates, D., & Mehta, P. (1997). Early interventions for children with reading problems. Scientific Studies of Reading, 1(3), 255-276.

Foorman, B.R., Francis, D.J., Shaywitz, S.E., Shaywitz, B.A., & fletcher, J.M. (1997). The case for early reading interventions. In B. Blachman (Ed.), Foundations of reading acquisition and dyslexia: Implications for early intervention (pp. 243-264). Mahwah, JH: Lawrence Erlbaum Associates.

Fromkin, V. & Rodman, R. (1993). An introduction to language (4th ed.). New York: Holt, Rinehart & Winston.

Hatcher, P.J., Hulme, C., & Ellis, A.W. (1994). Ameliorating early reading failure by integrating the teaching of reading and phonological skills: The phonological linkage hypothesis. Child Development, 65, 41-57.

Hull, M. (1995). Phonics for the teacher of reading (4th ed.). Columbus, OH: Charles E. Merrill.
Juel, C. (1991). Beginning reading. In R. Barr, M.L. Kamil, P.B. Mosenthal, & P.D. Pearson (Eds.), Handbook of reading research (Vol. 2, pp 759-788). New York: Longman.

Liberman, I.Y., Rubin, H., Duques, S., & Carlisle, J. (1985). Linguistic abilities and spelling proficiency in kindergartners and adult poor spellers. In D.B. Gray & J.F. Kavanagh (Eds.), Biobehavioural measures of dyslexia (pp. 163-176). Timonium, MD: York Press.

Lindamood, C., & Lindamood, P. (1975). The A.D.D. Program: Auditory Discrimination in Depth. Austin, TX: PRO-ED.

Lundberg, I., Frost, J., & Peterson, O.P. (1988). Effects of an extensive program for stimulating phonological awareness in preschool children. Reading Research Quarterly, 23, 264-284.

Lundberg, I., Olofsson, A., & Wall, S. (1980). Reading and spelling skills in the first school years predicted from phonemic awareness skills in kindergarten. Scandinavian Journal of Psychology, 21, 159-173.

Marcel, A. (1980). Phonological awareness and phonological representation: Investigation of a specific spelling problem. In U. Frith (Ed.), Cognitive processes in spelling (pp. 373-403). New York: Academic Press.

Moats, L.C. (1995). Spelling: Development, disability, and instruction. Timonium, MD: York Press.
Morais, J., Cary, L., Alegria, J., & Bertelson, P. (1979). Does awareness of speech as a sequence of phonemes arise spontaneously? Cognition, 7, 323-331.

Parker, F., & Riley, K. (1994). Linguistics for non-linguists: A primer with exercises (2nd ed.). Needham, MA: Allyn & Bacon.

Stanovich, K.E. (1986). Matthew effects in reading: Some consequences of individual differences in the acquisition of literacy. Reading Research Quarterly, 21, 360-406.

Treiman, R. (1993). Beginning to spell: A study of first grade children. New York: Oxford University Press.

Tunmer, W.E., & Nesdale, A.R. (1985). Phonemic segmentation skill and beginning reading. Journal of Educational Psychology, 77, 417-427.

Wagner, R., Torgesen, J.K., & Rashotte, C.A. (1994). Development of reading-related phonological processing abilities: New evidence of bidirectional causality from a latent variable longitudinal study. Developmental Psychology: 30, 73-87.

Wallach, L., Wallach, M.A., Dozier, M.G., & Kaplan, N.E. (1977). Poor children learning to read do not have trouble with auditory discrimination but do have trouble with phoneme recognition. Journal of Educational Psychology, 69, 36-39.

Wallach, M.A., & Wallach, L. (1979). Helping disadvantaged children learn to read by teaching them phoneme identification skills. In L.A. Resnick & P.A. Weaver (Eds.), Theory and practice of early reading (Vol. 3, pp. 227-259). Hillsdale, NJ: Lawrence Erlbaum Associates.

Williams, J.P. (1980). Teaching decoding with a special emphasis on phoneme analysis and phoneme blending. Journal of Educational Psychology, 72, 1-15.

Processing Speed

Processing speed is how quickly a student can respond to information, react to questions, understand what is asked and give appropriate responses. Processing speed may affect conversations, reading speed, the ability to keep up with taking notes, and even how quickly someone might complete their math “mad minute” assignment. However, if this is just an isolated issue, for example a student is only slow when doing homework, it may not be a processing speed issue at all. (This is one reason we do pre-testing!)

Speed of information processing is not the same as intelligence. It is possible to be very bright, yet process information slowly. It is also not the same as speed on the sports field. Adults are often heard to say of these students, “he can come up with the right answer if I wait long enough for him to think it through.”

Processing can be impacted by a variety of factors. Neurologically, speed is affected by neurotransmitters in the brain and their balance, by the fatty covering of neurons (myelin) that speeds transmission, by the size of synaptic spaces (unusually large synaptic gaps slowing information processing), by the organization of neural networks that support a concept or procedure, and by the efficiency of the frontal lobes in organizing and directing information flow.

Speed is also affected by knowledge, experience, and practice. The more a person knows about a topic, the easier it is to process new information about that topic quickly. The more experience a person has with a phenomenon, the easier it is to react and think quickly. For example, at first, a board game, card game, video game, or sport can take a great deal of time to do what takes very little time once the game is mastered. Similarly, a foreign language at first seems to be spoken very rapidly. But once the language begins to be mastered, it gives the impression of sounding slower. That is processing speed at work. Therefore, increasing familiarity with routines in and out of school and increasing content knowledge is very important for individuals who process information slowly. Even better, improve processing speed itself.

Processing speed is often difficult to improve because there are so many factors that affect speed of response. So, Cognitive Educational Therapy takes students one small successful step at a time, having them complete specially designed tasks at ever increasing speed.

The following is a sampling of research on how improving processing speed affects learning:
Azar, B. (2000). What's the link between speed and reading in children with dyslexia? Monitor on Pscyhology. March, 36-39.

Brand, Ch. (1981). General intelligence and mental speed: Their relationship and development. In P. Friedman, P. Das, & N. O’Connor (Eds.), Intelligence and learning (pp. 589–593). New York, Plenum Press.

Deary, I. J. (2001). Reaction times and intelligence differences: A population-based cohort study. Intelligence, 29, 389–399.

Grudnik, J. L., & Kranzler, J. H. (2001). Meta-analysis of the relationship between intelligence and inspection time. Intelligence, 29, 523–535.

Kail, R. V., & Ferrer, E. (2007). Processing speed in childhood and adolescence:
Longitudinal models for examining developmental change. Child Development,
78, 1760-1770.

Kail, R., & Hall, L. K. (1994). Processing speed, naming speed, and reading.
Developmental Psychology, 30, 949-954.

Kail, R., Hall, L. K., & Caskey, B. J. (1999). Processing speed, exposure to print, and naming speed. Applied Psycholinguistics, 20, 303–314.

Kail, R., & Park, Y. (1992). Global developmental change in processing time. Merrill-Palmer Quarterly, 38, 525–541.

Lindley, R. H., Smith, W. R., & Thomas, J. Th. (1988). The relationship between speed of information processing as measured by timed paper-and-pencil tests and psychometric intelligence. Intelligence, 12, 17–25.

Nettelbeck, T., & Young, R. (1990). Inspection time and intelligence in 7-yr-old children: A follow-up. Personality and Individual Differences, 11, 1283–1289.

 

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