Brain Rehabilitation for Formerly Lead Poisoned Children

1. Brain Rehabilitation for Formerly Lead Poisoned Children Working Memory Training Teresa Holtrop MD June 7, 2012

6. 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?

7. 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)

8. 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)

9. Show Cogmed

10. 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.

11. Working Hypothesis Adaptive working memory training will improve working memory performance in previously lead poisoned children

12. 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

13. 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

14. 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).

15. Exclusion criteria Major medical conditions that preclude participation in a daily computer training intervention. IQ<70

16. Testing Schedule Child 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

17. 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

18. COGMED Program Scores Pillai’s Trace F=191.86, p<.001

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

20. Math Composite Score Pillai’s Trace F=16.75, p=.001

21. Reading Composite Score Pillai’s Trace F=2.78, p=.116

22. 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

25. 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.

26. 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