Brain and Cognition 79 (2012) 159–179 Contents lists available at SciVerse ScienceDirect Brain and Cognition journal homepage: www.elsevier.com/locate/b&c Special Invited Review Training the brain: Fact and fad in cognitive and behavioral remediation ⇑ Sheida Rabipour a, Amir Raz a,b, a Department of Neurology & Neurosurgery, McGill University, Canada b Departments of Psychiatry & Psychology, McGill University, Canada article info abstract Article history: Putatively safe and effective for improving cognitive performance in both health and disease, products Accepted 13 February 2012 purported to train the brain appeal to consumers and healthcare practitioners. In an increasingly Available online 30 March 2012 health-centered society, these applications constitute a burgeoning commercial market. Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such Keywords: brain training largely unsubstantiated. On the other hand, at least some scientific findings seem to sup- Attention port the effectiveness and sustainability of training for higher brain functions such as attention and work- Brain training ing memory. In the present paper we provide a tectonic integration and synthesis of cognitive training Cognitive remediation approaches. Specifically, we sketch the relative merits and shortcomings of these programs, which often Computerized training programs Neuroplasticity appeal to parents who must choose between side-effect-laden medication and other less conventional Working memory options. Here we examine how neuroplasticity allows the healthy as well the impaired to benefit from cognitive training programs. We evaluate the evidence and consider whether brain training can be a stand-alone treatment or an adjunct to pharmacotherapy, outline promising future prospects, and high- light what training outcomes are plausible in line with available data. Future research would determine whether the field of brain training realizes its potential to revolutionize education and rehabilitation or withers away engulfed in controversy. Ó 2012 Elsevier Inc. All rights reserved. 1. Introduction or general cognitive ability as a result of repetition over a circum- scribed timeframe. Such training can produce changes measured at Increasingly ubiquitous, training programs foster the putative the behavioral as well as the neuroanatomical and functional lev- promise of enhancing or rehabilitating behavior and brain func- els. Many forms of brain training appear to improve cognitive func- tion. This trend comprises a burgeoning market of products alleged tion and emotional control, particularly programs that exercise to enhance cognition, emotion, thought and action. Catering to attention (Rueda, Posner, and Rothbart, 2005). By practicing games individuals of all ages, but targeting young children and the elderly or tasks that require choosing between two competing responses, in particular, such programs claim to benefit healthy populations the training of attention aims to strengthen the neural networks as well as those diagnosed with specific disorders. Many commer- underlying control processes (Raz & Buhle, 2006). A strong modu- cial programs take advantage of computerized training over the lator of cognition and affect, attention refers to the selective focus Internet, offering the comfort and privacy of home-based brain on specific aspects of our environment or to the concentration on exercise. Appealing to a wide clientele – from the ambitious and specific mental thoughts and operations (Raz & Buhle, 2006). Sim- healthy to the desperate and sick – brain training targets parents ilar to attention training (AT), many programs target working and professionals looking for an edge in a competitive society, memory (WM), a system that mediates temporary information symptom relief, or a potential cure. storage, modification, and protection from interference (Bledowski, Broadly defined, brain training refers to the engagement in a Kaiser, & Rahm, 2010). Apart from attention and WM, studies sug- specific program or activity that aims to enhance a cognitive skill gest that practicing sustained attention through meditation (Tang & Posner, 2009), schooling (Diamond, Barnett, Thomas, & Munro, 2007), interaction with nature (Kaplan, 1995a), exercise (Kubesch Abbreviations: AT, attention training; WM, working memory; FFW-L, Fast et al., 2009), and musical training (Kraus & Chandrasekaran, ForWord-Language; HRT, habit-reversal training; IBMT, integrative body-mind training; BBC, British Broadcasting Corporation; AKTIVA, Active Cognitive Stimu- 2010) can also improve cognitive ability and emotional control. lation-Prevention in the Elderly; TS, Tourette’s Syndrome; COI, conflicts of interest. The effects of such varied methods on cognitive ability and emo- ⇑ Corresponding author. Address: Institute of Community and Family Psychiatry, tional stability attest to the advantages of specific exercises. 4333 Cote Ste. Catherine, Montreal, QC, H3W 1E4 Canada. E-mail address: [email protected] (A. Raz). 0278-2626/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.bandc.2012.02.006 160 S. Rabipour, A. Raz / Brain and Cognition 79 (2012) 159–179 Brain training is especially relevant for developmental psycho- training as an adjunct – or possible substitute – to current drug- pathology. This approach has potential to ameliorate undesired based therapies for children with psychopathologies. We conclude symptoms of disorders such as attention deficit hyperactivity dis- by discussing specific conflicts that may hinder the advancement order (ADHD), a condition characterized by deficits in behavioral of research in this field and outline plausible outcomes of brain inhibition associated with cognitive processes that mediate goal- training with regards to factors that may alleviate or aggravate directed behaviors (Barkley, 1997). ADHD comprises a useful lens undesirable childhood behavior. through which researchers examine the effects of training. A spec- trum disorder, ADHD contains various degrees of severity that in- 2. Neural and behavioral basis of brain training flict mild to severe impairments, many of which relate to executive attention and may improve as a result of training (Illes Attention plays a central role in social behavior and academic & Sahakian, 2011). Currently, primary treatments for developmen- performance. Due to brain plasticity, training can alter the neural tal psychopathologies such as ADHD often involve psychotropic correlates of attention and improve attentional control. In this sec- medications, which sometimes show marginal effects. Even these tion, we focus on a current, widely recognized model that subdi- effects, however, attenuate over time and can generate a number vides attention into three separate systems. We discuss the of unwanted side-effects. As a result, parents and clinicians are of- function of these systems as well as their related neural networks, ten reluctant to embrace drug-based therapy despite the scarcity of and delineate how these systems control behavior throughout safe and effective treatment alternatives. Recent allegations add development. Ultimately, we underline why attention is a suitable controversy to this dilemma by claiming that certain psychiatrists faculty to train in both children and adults. may have surreptitious ties with drug companies, biasing the re- search surrounding the production and distribution of medication for youth (‘‘Credibility Crisis in Pediatric Psychiatry,’’ 2008). In light 2.1. Neuroplasticity and training of such limitations in pharmacological-based remedies, brain training may represent an attractive adjunct to common pharma- Brain training thrives on the lure of neuroplasticity, a change in cological treatment. neural structure and function in response to experience or environ- The generalizability of brain training represents one of the ma- mental stimulation (Shaw, Lanius, & Vandendoel, 1994). Research jor claims-to-fame of publicly distributed programs. With scarce suggests that both genetic and environmental factors impact the data to support advertised claims, however, patrons of brain train- development and physical structure of the brain (Lenroot & Giedd, ing often invest considerable resources pursuing programs that 2008). Investigations of executive attention in children have promote unsupported, arguably unrealistic, outcomes. While stud- uncovered notable disparities associated with socio-economic sta- ies of computerized AT and working memory training (WMT) tus, even when performance levels are comparable (Hackman & show, perhaps unsurprisingly, that trainees can improve signifi- Farah, 2009; Mezzacappa, 2004). Other studies report that severe cantly on cognitive skills related to the intervention (Westerberg stress and maltreatment experienced early in life can severely im- et al., 2007), at least some findings suggest that training may gen- pact neuroanatomy, showing reduced volumes and attenuated eralize beyond task-specific skills and apply to untrained overarch- development of several neural structures (Teicher et al., 2003). Ta- ing abilities (Jaeggi, Buschkuehl, Jonides, & Perrig, 2008; Jaeggi ken together, these findings indicate that the developing brain is et al., 2010). Reported improvements sometimes extend to in- susceptible to change in response to environmental stimuli. creased fluid intelligence, which refers to the ability to solve prob- Evidence suggests that neuroplastic