attention problems

How urban living affects attention

February, 2013

A comparison of traditional African villagers and those who have moved to town indicates that urban living improves working memory capacity even as it makes us more vulnerable to distraction.

Another study looking into the urban-nature effect issue takes a different tack than those I’ve previously reported on, that look at the attention-refreshing benefits of natural environments.

In this study, a rural African people living in a traditional village were compared with those who had moved to town. Participants in the first experiment included 35 adult traditional Himba, 38 adolescent traditional Himba (mean age 12), 56 adult urbanized Himba, and 37 adolescent urbanized Himba. All traditional Himba had had little contact with the Western world and only spoke their native language; all adult urbanized Himba had grown up in traditional villages and only moved to town later in life (average length of time in town was 6 years); all adolescent urbanized Himba had grown up in town the town and usually attended school regularly.

The first experiments assessed the ability to ignore peripheral distracting arrows while focusing on the right or left direction of a central arrow.

There was a significant effect of urbanization, with attention being more focused (less distracted) among the traditional Himba. Traditional Himba were also slower than urbanized Himba — but note that there was substantial overlap in response times between the two groups. There was no significant effect of age (that is, adolescents were faster than adults in their responses, but the effect of the distracters was the same across age groups), or a significant interaction between age and urbanization.

The really noteworthy part of this, was that the urbanization effect on task performance was the same for the adults who had moved to town only a few years earlier as for the adolescents who had grown up and been educated in the town. In other words, this does not appear to be an educational effect.

The second experiment looked at whether traditional Himba would perform more like urbanized Himba if there were other demands on working memory. This was done by requiring them to remember three numbers (the number words in participants’ language are around twice as long as the same numbers in English, hence their digit span is shorter).

While traditional Himba were again more focused than the urbanized in the no-load condition, when there was this extra load on working memory, there was no significant difference between the two groups. Indeed, attention was de-focused in the traditional Himba under high load to the same degree as it was for urbanized Himba under no-load conditions. Note that increasing the cognitive load made no difference for the urbanized group.

There was also a significant (though not dramatic) difference between the traditional and urbanized Himba in terms of performance on the working memory task, with traditional Himba remembering an average of 2.46/3 digits and urbanized Himba 2.64.

Experiment 3 tested the two groups on a working memory task, a standard digit span test (although, of course, in their native language). Random sequences of 2-5 digits were read out, with the participant being required to say them aloud immediately after. Once again, the urbanized Himba performed better than the traditional Himba (4.32 vs 3.05).

In other words, the problem does not seem to be that urbanization depletes working memory, rather, that urbanization encourages disengagement (i.e., we have the capacity, we just don’t use it).

In the fourth experiment, this idea was tested more directly. Rather than the arrows used in the earlier experiments, black and white faces were used, with participants required to determine the color of the central face. Additionally, inverted faces were sometimes used (faces are stimuli we pay a lot of attention to, but inverting them reduces their ‘faceness’, thus making them less interesting).

An additional group of Londoners was also included in this experiment.

While urbanized Himba and Londoners were, again, more de-focused than traditional Himba when the faces were inverted, for the ‘normal’ faces, all three groups were equally focused.

Note that the traditional Himba were not affected by the changes in the faces, being equally focused regardless of the stimulus. It was the urbanized groups that became more alert when the stimuli became more interesting.

Because it may have been a race-discrimination mechanism coming into play, the final experiment returned to the direction judgment, with faces either facing left or right. This time the usual results occurred – the urbanized groups were more de-focused than the traditional group.

In other words, just having faces was not enough; it was indeed the racial discrimination that engaged the urbanized participants (note that both these urban groups come from societies where racial judgments are very salient – multicultural London, and post-apartheid Namibia).

All of this indicates that the attention difficulties that appear so common nowadays are less because our complex environments are ‘sapping’ our attentional capacities, and more because we are in a different attentional ‘mode’. It makes sense that in environments that contain so many more competing stimuli, we should employ a different pattern of engagement, keeping a wider, more spread, awareness on the environment, and only truly focusing when something triggers our interest.

Reference: 

[3273] Linnell, K. J., Caparos S., de Fockert J. W., & Davidoff J.
(2013).  Urbanization Decreases Attentional Engagement.
Journal of experimental psychology. Human perception and performance.

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Menopause forgetfulness greatest early in postmenopause

January, 2013

A smallish study suggests that the cognitive effects of menopause are greatest in the first year after menopause.

Being a woman of a certain age, I generally take notice of research into the effects of menopause on cognition. A new study adds weight, perhaps, to the idea that cognitive complaints in perimenopause and menopause are not directly a consequence of hormonal changes, but more particularly, shows that early post menopause may be the most problematic time.

The study followed 117 women from four stages of life: late reproductive, early and late menopausal transition, and early postmenopause. The late reproductive period is defined as when women first begin to notice subtle changes in their menstrual periods, but still have regular menstrual cycles. Women in the transitional stage (which can last for several years) experience fluctuation in menstrual cycles, and hormone levels begin to fluctuate significantly.

Women in the early stage of post menopause (first year after menopause), as a group, were found to perform more poorly on measures of verbal learning, verbal memory, and fine motor skill than women in the late reproductive and late transition stages. They also performed significantly worse than women in the late menopausal transition stage on attention/working memory tasks.

Surprisingly, self-reported symptoms such as sleep difficulties, depression, and anxiety did not predict memory problems. Neither were the problems correlated with hormone levels (although fluctuations could be a factor).

This seemingly contradicts earlier findings from the same researchers, who in a slightly smaller study found that those experiencing poorer working memory and attention were more likely to have poorer sleep, depression, and anxiety. That study, however, only involved women approaching and in menopause. Moreover, these aspects were not included in the abstract of the paper but only in the press release, and because I don’t have access to this particular journal, I cannot say whether there is something in the data that explains this. Because of this, I am not inclined to put too much weight on this point.

But we may perhaps take the findings as support for the view that cognitive problems experienced earlier in the menopause cycle are, when they occur, not a direct result of hormonal changes.

The important result of this study is the finding that the cognitive problems often experienced by women in their 40s and 50s are most acute during the early period of post menopause, and the indication that the causes and manifestations are different at different stages of menopause.

It should be noted, however, that there were only 14 women in the early postmenopause stage. So, we shouldn’t put too much weight on any of this. Nevertheless, it does add to the picture research is building up about the effects of menopause on women’s cognition.

While the researchers said that this effect is probably temporary — which was picked up as the headline in most media — this was not in fact investigated in this study. It would be nice to have some comparison with those, say, two or three and five years post menopause (but quite possibly this will be reported in a later paper).

Reference: 

[3237] Weber, M. T., Rubin L. H., & Maki P. M.
(2013).  Cognition in perimenopause.
Menopause: The Journal of The North American Menopause Society.

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Worry & fatigue main reason for ‘chemo-brain’?

January, 2013

A new study points to pre-treatment reasons for declined cognitive function following chemotherapy, and suggests that anxiety may be the main driver.

The issue of ‘chemo-brain’ — cognitive impairment following chemotherapy — has been a controversial one. While it is now (I hope) accepted by most that it is, indeed, a real issue, there is still an ongoing debate over whether the main cause is really the chemotherapy. A new study adds to the debate.

The study involved 28 women who received adjuvant chemotherapy for breast cancer, 37 who received radiotherapy, and 32 age-matched healthy controls. Brain scans while doing a verbal working memory task were taken before treatment and one month after treatment.

Women who underwent chemotherapy performed less accurately on the working memory task both before treatment and one month after treatment. They also reported a significantly higher level of fatigue. Greater fatigue correlated with poorer test performance and more cognitive problems, across both patient groups and at both times (although the correlation was stronger after treatment).

Both patient groups showed reduced function in the left inferior frontal gyrus, before therapy, but those awaiting chemotherapy showed greater impairment than those in the radiotherapy group. Pre-treatment difficulty in recruiting this brain region in high demand situations was associated with greater fatigue after treatment.

In other words, reduced working memory function before treatment began predicted how tired people felt after treatment, and how much their cognitive performance suffered. All of which suggests it is not the treatment itself that is the main problem.

But the fact that reduced working memory function precedes the fatigue indicates it’s not the fatigue that’s the main problem either. The researchers suggest that the main driver is level of worry —worry interfered with the task; level of worry was related to fatigue. And worry, as we know, can reduce working memory capacity (because it uses up part of it).

All of which is to say that support for cancer patients aimed at combating stress and anxiety might do more for ‘chemo-brain’ than anything else. In this context, I note also that there have been suggestions that sleep problems have also been linked to chemo-brain — a not unrelated issue!

Reference: 

Cimprich, B. et al. 2012. Neurocognitive impact in adjuvant chemotherapy for breast cancer linked to fatigue: A Prospective functional MRI study. Presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, Dec. 4-8

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Poverty affects brain development through attention needs

December, 2012

One reason for the association between poverty and poorer cognition in children may lie in how poverty affects attention, with poor children tending to use more cognitive resources in monitoring the environment.

There have been a number of studies in the past few years showing how poverty affects brain development and function. One of these showed specifically that children of high and low socioeconomic status showed differences in brain wave patterns associated with an auditory selective attention task. This was thought to indicate that the groups were using different mechanisms to carry out the task, with the lower SES children employing extra resources to attend to irrelevant information.

In a follow-up study, 28 young adolescents (12-14 years) from two schools in neighborhoods of different socioeconomic status answered questions about their emotional and motivational state at various points during the day, and provided saliva samples to enable monitoring of cortisol levels. At one point in the afternoon, they also had their brainwaves monitored while they carried out an auditory selective attention task (hearing different sounds played simultaneously into both ears, they were required to press a button as fast as possible when they heard one particular sound).

While performance on the task was the same for both groups, there were, once again, differences in the brain wave patterns. Higher SES children exhibited far larger theta waves in the frontal lobes in response to sounds they attended to than to compared to those they should have ignored, while lower SES children showed much larger theta waves to the unattended sounds than for the attended sounds.

While the lower SES children had higher cortisol levels throughout the school day, like the higher SES children, they showed little change around the task, suggesting neither group was particularly stressed by the task. Both groups also showed similar levels of boredom and motivation.

What the findings suggest is that lower SES children have to exert more cognitive control to avoid attending to irrelevant stimuli than higher SES children — perhaps because they live in more threatening environments.

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Why acute stress makes it hard to think properly

October, 2012

A rat study indicates that acute stress disrupts feedback loops in the prefrontal cortex that may be keeping information alive in working memory.

Stress is a major cause of workplace accidents, and most of us are only too familiar with the effects of acute stress on our thinking. However, although the cognitive effects are only too clear, research has had little understanding of how stress has this effect. A new rat study sheds some light.

In the study, brain activity was monitored while five rats performed a working memory task during acute noise stress. Under these stressful conditions, the rats performed dramatically worse on their working memory task, with performance dropping from an average of 93% success to 65%.

The stress also significantly increased the discharge rate of a subset of neurons in the medial prefrontal cortex during two phases of the task: planning and assessment.

This brain region is vital for working memory and executive functions such as goal maintenance and emotion regulation. The results suggest that the firing and re-firing of these neurons keeps recent information ‘fresh’. When the re-firing is delayed, the information can be lost.

What seems to be happening is that the stress is causing these neurons to work even more furiously, but instead of performing their normal task — concentrating on keeping important information ‘alive’ during brief delays — they are reacting to all the other, distracting and less relevant, stimuli.

The findings contradict the view that stress simply suppresses prefrontal cortex activity, and suggests a different approach to treatment, one that emphasizes shutting out distractions.

The findings are also exciting from a theoretical viewpoint, suggesting as they do that this excitatory recursive activity of neurons within the prefrontal cortex provide the neural substrate for working memory. That is, that we ‘hold’ information in the front of our mind through reverberating feedback loops within this network of neurons, that keep information alive during the approximately 1.5 seconds of our working memory ‘span’.

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Large drop in IQ in those who smoked marijuana regularly as teens

September, 2012

Persistent marijuana use beginning before age 18 (but not after) is associated with a significant drop in IQ in a large, long-running study.

A large long-running New Zealand study has found that people who started using cannabis in adolescence and continued to use it for years afterward showed a significant decline in IQ from age 13 to 38. This was true even in those who hadn’t smoked marijuana for some years.

The study has followed a group of 1,037 children born in 1972-73. At age 38, 96% of the 1004 living study members participated in the latest assessment. Around 5% were regularly smoking marijuana more than once a week before age 18 (cannabis use was ascertained in interviews at ages 18, 21, 26, 32, and 38 years, and this group was not more or less likely to have dropped out of the study).

This group showed an average decline in IQ of 8 points on cognitive tests at age 38 compared to scores at age 13. Such a decline was not found in those who began using cannabis after the age of 18. In comparison, those who had never used cannabis showed a slight increase in IQ. The effect was dose-dependent, with those diagnosed as cannabis dependent on three or more occasions showing the greatest decline.

While executive function and processing speed appeared to be the most seriously affected areas, impairment was seen across most cognitive domains and did not appear to be statistically significantly different across them.

The size of the effect is shown by a further measure: informants (nominated by participants as knowing them well) also reported significantly more attention and memory problems among those with persistent cannabis dependence. (Note that a decline of 8 IQ points in a group whose mean is 100 brings it down to 92.)

The researchers ruled out recent cannabis use, persistent dependence on other drugs (tobacco, alcohol, hard drugs), and schizophrenia, as alternative explanations for the effect. The effect also remained after years of education were taken into account.

The finding supports the view that the adolescent brain is vulnerable to the effects of marijuana, and that these effects are long-lasting and significant.

Some numbers for those interested: Of the 874 participants included in the analysis (those who had missed at least 3 interviews in the 25 years were excluded), 242 (28%) never used cannabis, 479 (55%) used it but were never diagnosed as cannabis-dependent, and 153 (17%) were diagnosed on at least one of the interviews as cannabis-dependent. Of these, 80 had been so diagnosed on only one occasion, 35 on two occasions, and 38 on three or more occasions. I note that the proportion of males was significantly higher in the cannabis-dependent groups (39% in never used; 49% in used but never diagnosed; 70%, 63%, 82% respectively for the cannabis-dependent).

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How meditation may improve multitasking and attention

September, 2012

Three recent studies show that meditation training reduces the stress of multitasking and reduces task-switching, that it improves white matter efficiency, and that the improved executive control may be largely to do with better emotional awareness and regulation.

Meditation may improve multitasking

I recently reported that developing skill at video action games doesn’t seem to improve general multitasking ability, but perhaps another approach might be more successful. Meditation has, of course, been garnering growing evidence that it can help improve attentional control. A new study extends that research to multitasking in a realistic work setting.

The study involved three groups of 12-15 female human resource managers, of whom one group received eight weeks of mindfulness-based meditation training, another received eight weeks of body relaxation training, and another initially received no training (control), before receiving the mindfulness training after the eight weeks.

Before and after each eight-week period, the participants were given a stressful test of their multitasking abilities, requiring them to use email, calendars, instant-messaging, telephone and word-processing tools to perform common office tasks (scheduling a meeting; finding a free conference room; writing a draft announcement of the meeting, eating snacks and drinking water, writing a memo proposing a creative agenda item for the meeting). Necessary information came from emails, instant messages, telephone calls, and knocks on the door. The participants had 20 minutes to complete the tasks.

The meditation group reported lower levels of stress during the multitasking test compared to the control and relaxation groups. They also spent more time on tasks and switched tasks less often, while taking no longer to complete the overall job than the others. Both meditation and relaxation groups showed improved memory for the tasks they were performing.

After the control group underwent the meditation training, their results matched those of the meditation group.

The meditation training emphasized:

  • control of attentional focus
  • focusing attention in the present moment or task
  • switching focus
  • breath and body awareness.

The relaxation training emphasized progressive tensing and relaxing of major muscle groups, aided by relaxation imagery.

It's interesting that overall time on task didn't change (the researchers remarked that the meditators didn't take any longer, but of course most of us would be looking for it to become shorter!), but I wouldn't read too much into it. The task was relatively brief. It would be interesting to see the effects over the course of, say, a day. Nor did the study look at how well the tasks were done.

But it is, of course, important that meditation training reduced task-switching and stress. Whether it also has a postitive effect on overall time and quality of work is a question for another day.

IBMT improves white matter efficiency

A recent imaging study has found that four weeks of a form of mindfulness meditation called integrative body–mind training (IBMT) improved white matter efficiency in areas surrounding the anterior cingulate cortex, compared to controls given relaxation training.

The anterior cingulate is part of the brain network related to self-regulation. Deficits in activation in this part of the brain have been associated with attention deficit disorder, dementia, depression, schizophrenia, and other disorders.

Using the data from a 2010 study involving 45 U.S. college students, and another involving 68 Chinese students, researchers found that axon density (one factor in white matter efficiency) had improved after two weeks, but not myelin formation. After a month (about 11 hours of meditation), both had improved. Mood improved by two weeks.

Previous studies involving computer-based training for improving working memory have found changes in myelination, but not axon density.

Meditators’ better cognitive control may be rooted in emotional regulation

Previous work has found that people who engage in meditation show higher levels of executive control on laboratory tasks.

An electrical signal called the Error Related Negativity (ERN) occurs in the brain within 100 ms of an error being committed. When meditators and non-meditators were given the Stroop Test, meditators not only tended to do better on the test, but their ERNs were stronger.

The interesting thing about this is that the best performers were those who scored highest on emotional acceptance. Mindful awareness was less important. It’s suggested that meditators may be able to control their behavior better not because of their sharper focus, but because they are more aware of their emotions and regulate them better.

Something to think about!

Reference: 

Levy, D. M., Wobbrock, J. O., Kaszniak, A. W., & Ostergren, M. (2012). The Effects of Mindfulness Meditation Training on Multitasking in a High-Stress Information Environment, 45–52. Full text available at http://faculty.washington.edu/wobbrock/pubs/gi-12.02.pdf

[3051] Tang, Y-Y., Lu Q., Fan M., Yang Y., & Posner M. I.
(2012).  Mechanisms of white matter changes induced by meditation.
Proceedings of the National Academy of Sciences. 109(26), 10570 - 10574.

[3052] Teper, R., & Inzlicht M.
(2012).  Meditation, mindfulness and executive control: the importance of emotional acceptance and brain-based performance monitoring.
Social Cognitive and Affective Neuroscience.

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Nature walks improve cognition in people with depression

June, 2012

A small study provides more support for the idea that viewing nature can refresh your attention and improve short-term memory, and extends it to those with clinical depression.

I’ve talked before about Dr Berman’s research into Attention Restoration Theory, which proposes that people concentrate better after nature walks or even just looking at nature scenes. In his latest study, the findings have been extended to those with clinical depression.

The study involved 20 young adults (average age 26), all of whom had a diagnosis of major depressive disorder. Short-term memory and mood were assessed (using the backwards digit span task and the PANAS), and then participants were asked to think about an unresolved, painful autobiographical experience. They were then randomly assigned to go for a 50-minute walk along a prescribed route in either the Ann Arbor Arboretum (woodland park) or traffic heavy portions of downtown Ann Arbor. After the walk, mood and cognition were again assessed. A week later the participants repeated the entire procedure in the other location.

Participants exhibited a significant (16%) increase in attention and working memory after the nature walk compared to the urban walk. While participants felt more positive after both walks, there was no correlation with memory effects.

The finding is particularly interesting because depression is characterized by high levels of rumination and negative thinking. It seemed quite likely, then, that a solitary walk in the park might make depressed people feel worse, and worsen working memory. It’s intriguing that it didn’t.

It’s also worth emphasizing that, as in earlier studies, this effect of nature on cognition appears to be independent of mood (which is, of course, the basic tenet of Attention Restoration Theory).

Of course, this study is, like the others, small, and involves the same demographic. Hopefully future research will extend the sample groups, to middle-aged and older adults.

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Menopause ‘brain fog’ a product of poor sleep and depression?

May, 2012

A smallish study of women approaching and in menopause found that some experienced poorer working memory and attention, and these were more likely to have poorer sleep, depression, and anxiety.

A study involving 75 perimenopausal women aged 40 to 60 has found that those with memory complaints tended to show impairments in working memory and attention. Complaints were not, however, associated with verbal learning or memory.

Complaints were also associated with depression, anxiety, somatic complaints, and sleep disturbance. But they weren’t linked to hormone levels (although estrogen is an important hormone for learning and memory).

What this suggests to me is that a primary cause of these cognitive impairments may be poor sleep, and anxiety/depression. A few years ago, I reported on a study that found that, although women’s reports of how many hot flashes they had didn’t correlate with memory impairment, an objective measure of the number of flashes they experienced during sleep did. Sleep, as I know from personal experience, is of sufficient importance that my rule-of-thumb is: don’t bother looking for any other causes of attention and memory deficits until you have sorted out your sleep!

Having said that, depressive symptoms showed greater relationship to memory complaints than sleep disturbance.

It’s no big surprise to hear that it is working memory in particular that is affected, because what many women at this time of life complain of is ‘brain fog’ — the feeling that your brain is full of cotton-wool. This doesn’t mean that you can’t learn new information, or remember old information. But it does mean that these tasks will be impeded to the extent that you need to hold on to too many bits of information. So mental arithmetic might be more difficult, or understanding complex sentences, or coping with unexpected disruptions to your routine, or concentrating on a task for a long time.

These sorts of problems are typical of those produced by on-going sleep deprivation, stress, and depression.

One caveat to the findings is that the study participants tended to be of above-average intelligence and education. This would protect them to a certain extent from cognitive decline — those with less cognitive reserve might display wider impairment. Other studies have found verbal memory, and processing speed, impaired during menopause.

Note, too, that a long-running, large population study has found no evidence for a decline in working memory, or processing speed, in women as they pass through perimenopause and menopause.

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Video games and impaired attention: a vicious circle

April, 2012

A large, long-running study suggests both that children with attention difficulties tend to spend more time playing video games, and that extensive video game playing is bad for attention.

A three-year study involving 3,034 Singaporean children and adolescents (aged 8-17) has found that those who spent more time playing video games subsequently had more attention problems, even when earlier attention problems, sex, age, race, and socioeconomic status were statistically controlled. Those who were more impulsive or had more attention problems subsequently spent more time playing video games, even when initial video game playing was statistically controlled. These findings suggest that the cause-effect relationship between video game playing and attention problems/impulsiveness goes both ways.

While the particular content may have an effect on attention problems and impulsiveness (violent games appeared to be an additional, independent, factor in attention problems), it was the total time spent that was more important.

Participants completed questionnaires about their video game playing habits annually for three years running. They also completed questionnaires aimed to measure attention and impulsiveness (the Current ADHD Symptoms Scale Self-Report, and the Barratt Impulsiveness Scale-11, respectively). Regarding attention, the children answered questions such as how often they "fail to give close attention to details or make careless mistakes" in their work or "blurt out answers before questions have been completed." For the impulsivity test, they selected points they felt described themselves, such as "I often make things worse because I act without thinking" or "I concentrate easily."

How does this finding relate to other evidence showing that playing video games can improve visual attention for rapid and accurate recognition of information from the environment? The answer lies in the different nature of attention — the attention needed for visual search differs in important ways from the attention necessary for sustained concentration in contexts that are often effortful and/or boring.

The example of many attention-challenged individuals makes this more understandable. Many parents of children with ADHD find that the only thing their child can concentrate on for a lengthy period is video games. The answer to that riddle is the rapidly changing nature of video games, and the way they are designed to grab the attention, with flashing lights and loud noises and moving images etc. The young person is not, therefore, improving their ability to focus in a way that is helpful for the school environment, or indeed for everyday life.

Unfortunately, this study suggests that it is precisely those people who are most in need of such ‘external supports’ for attention (‘grabbing’ stimuli such as lights and sounds and movement) — that is, those individuals who are least able to control their own attention — who are most likely to spend a lot of time playing such games. The games then weaken their attentional control even more, and so the cycle continues.

So this research answers the question ADHD parents tend to have: should I encourage my child to play video games a lot (given that it’s the only thing that holds their attention) or not? The answer, unfortunately, would seem to be: not. However, all is not lost. There are computer ‘games’ that are designed to help those with ADHD learn to concentrate in a way that is more useful (see the Topic collection on ADHD for more on this).

The American Academy of Pediatrics recommends one hour per day of total media screen time (including TV, DVDs, video games, Internet, iPad, etc.) for children in elementary school, and two hours for children in secondary school.

Reference: 

Gentile, D.A., Swing, E.L., Lim, C.G. & Khoo, A. 2012. Video game playing, attention problems, and impulsiveness: Evidence of bidirectional causality. Psychology of Popular Media Culture, Vol 1(1), Jan 2012, 62-70. doi: 10.1037/a0026969

Full text available at http://www.apa.org/pubs/journals/releases/ppm-1-1-62.pdf

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