Brain Rehabilitation for Formerly Lead Poisoned Children

Working Memory Training

Teresa Holtrop MD

June 7, 2012

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Special Education Status by Blood Lead Level

No Special Education Special Education

What to do about previously lead-poisoned children and school

performance?

• Brainstorming sessions organized by CLEARCorp USA, Sue Gunderson, Executive Director

• Options: – Parent behavior management training?– Cognitive intervention?– Working memory intervention?

What is Working Memory?

• Scratch-pad memory (the ability to keep information online for a brief period of time)

• Appears to play important role in learning and maintaining focused behavior (Gathercole et al., 2006; Kane et al., 2007; Alloway et al., 2010)

Support for Working Memory Intervention

• Evidence that lead poisoning affects working memory (Canfield et al., 2004), Lanphear et al., 2000, Bleecker et al., 2005)

• Computer training program available that has shown promise for children with ADHD (Cogmed)

Show Cogmed

Specific Aim• Collect pilot data assessing the impact

of a short-term adaptive computer-assisted training program (Cogmed) on neuropsychological functioning of previously lead poisoned, school-age children with special emphasis on working memory ability.

Working Hypothesis• Adaptive working memory training will

improve working memory performance in previously lead poisoned children

Expectation• Lead poisoned children will have similar

positive outcomes secondary to the intervention as has been previously described by other investigators for non-lead poisoned children with low working memory

• This research represents a first-of-its-kind intervention for lead poisoned children

• Important because it represents a fairly simple and easily accessed method of intervention that can be used in schools and other settings to help remediate school performance problems

Study inclusion criteria• Age 7-10 years old

• English as a primary language

• Not in Special Education (corrected to “Not cognitively impaired”)

• History of previous lead levels > 10 mcg/dL (target group).

Exclusion criteria• Major medical conditions that preclude

participation in a daily computer training intervention.

• IQ<70

Testing ScheduleChild Measures

•Working Memory:– WJIII– Seashore Rhythm

•IQ: – WJIII

•Attention & Executive Fx

– TOVA

•Achievement– WIAT

Caregiver Measures•Child Executive Function

– BRIEF

•Child Behavior– BASC

•ADHD Checklist•Family Functioning/Home environment/Parenting

– Beavers– HOME– FACES– Demographic questionnaire

Recruitment and Retention Issues

• Mobile population

• Difficult to find children who had been treated for lead poisoning when younger

• Public transportation issues

• Failing school district

Pillai’s Trace F=191.86, p<.001

COGMED Program Scores

Significantly Improved ScoresN=18, i.e. 5 controls, 13 EBL

Comparison of Pre-Post Cognitive Assessment

Pre Post

N Mean SD Mean SD t Sig Woodcock Johnson Test of Cognitive Abilities

Sound Blending 18 100.4 9.0 106.1 10.8 -2.61 0.018 Concept Formation 18 85.00 9.1 91.7 10.7 -2.45 0.026 Memory for Words 18 89.7 11.1 94.3 13.4 -2.46 0.025 WIAT

Math Problem Solving 18 80.9 10.6 87.2 15.4 -3.45 0.003 Numerical Operations 18 85.1 12.6 89.7 12.0 -4.14 0.001 Total Math Composite 18 82.7 10.7 87.9 13.1 -4.95 <.001 Oral Reading Fluency 18 86.6 18.4 89.6 17.0 -2.27 0.036 Basic Reading Composite 18 88.2 13.1 92.8 11.7 -2.37 0.030 Reading Comp & Fluency Composite 18 83.5 24.3 87.9 24.5 2.45 0.026

Math Composite Score

Pillai’s Trace F=16.75, p=.001

Reading Composite Score

Pillai’s Trace F=2.78, p=.116

Case study• 7 y/o boy, current lead poisoning, has

Sickle C disease

• Significant pica

• Underwent 6 chelations in past year, none previously

• In second grade, regular education

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Post

  Pre-1 Post-1 Pre-2 Post-2

WJ Verbal Comprehension - stand score 79 90 93 87

WJ visual-auditory learning - stand score 83 90 93 90

WJ spatial relations - stand score 70 94 89 84

WJ sound blending - stand score 103 110 112 114

WJ concept formation - stand score 78 89 78 88

WJ visual matching - stand score 73 88 72 80

WJ numbers reversed - stand score 104 94 84 100

WJ auditory working memory - stand score 50 78 79 84

WJ vis_aud learning delay - stand score 66 81 76 77

WJ retrieval fluency - stand score 61 86 56 69

WJ memory for words - stand score 93 99 86 103

WIAT_reading comprehension standard score 69 80 77 83

WIAT_Math Problem solving standard score 64 68 68 73

WIAT_Word reading standard score 68 75

WIAT_Pseudoword Decoding standard score 77 77 75 88

WIAT_Numerical Operations standard score 76 79 78 78

WIAT_Oral reading fluency standard score 49 63 71 78

WIAT_total reading composite standard score 64 71

WIAT_Basic reading composite standard score 73 76 75 82

WIAT_Mathematics composite standard score 69 79 72 75

Cogmed Completion Survey

• Done 6-8 wks after completion of training/assessment• N=12, overwhelmingly positive

• “Child is slowly going off ADD/ADHD meds, will soon go completely off”. Parent/guardian attributes this is directly due to participation in Cogmed.

• After completing the program, the child was excited to “look into the future” and started talking about going to college and the type of life she wanted to live. …conquering the program gave child the ability to see education as a goal and not a hurdle.

Thanks to:

• Funder: Children’s Research Center of MI• Research team: Nicole Phinney, Reshmi

Morris, Maryanne Swanson, Michelle Moineau, Luke Gladstone, Hannah Schottenfels, Joe Norman

• CLEARCorp USA: Sue Gunderson, Steve Hughes, Joseph Battaglia, Kathleen Zoppi, Carole Ann Beamon

• CLEARCorp Detroit: Mary Sue Schottenfels