Persuasion - one step at a time

A week or so ago I broached the subject of attending the Arrowsmith program with A-One.

A-One: Well I'm not going!

Mum: A-One, this program could really help you!  For example, if you wanted to do a course at TAFE, you could find it easier than when you were at school.  It could help you learn better.  You remember that you found writing difficult at school?  It could help you do that better.

A-One: I didn't find writing difficult.  It was what to write.

Mum: Yes, that's right.

A-One: Anyway, I'm not going!

Mum: This is very serious A-One.  When we're gone, what will you do? Where will you live? How will you get your groceries? Who will help you manage your insurances? Health cover? Tax returns? Your pension?  It's not right to those who love you, nor to the Australian public who fund your pension, if you don't take up an opportunity which may help you be able to do those things for yourself!  Surely you'll at least try it?

A-One: No, I'm not doing it!

Mum: This is so serious, we'll have to start thinking about making it a condition of you living in this house.

A-One: You can't do that!

Mum: You are 23 years of age and you need to be thinking about living more independently.

A-One: I'm not going anywhere!

Mum: What are you objecting to so much?

A-One: I don't need it.

Mum: And yet you don't have a job, nor a driver's licence, nor able to take on responsibilities that others your age are already doing.

A-One: That's not my fault! Employers should give me a job!  They should give me a chance!

Mum: Don't you want to give yourself the best chance?

A-One: Yes, but I'm not that bad. I don't need it.

Mum: That's right. You're quite capable of many things. But this program is for people who are already good at some things, but have some blockages in their brain that stop them from doing other things.

A-One: I'm not doing it.

Mum: A-One. Has it been your experience that people often get frustrated with you? That they lose patience with you? For all your life so far?

A-One: Yes.

Mum: Do you want it to be that way for the rest of your life?  Do you think we want it that way? There's a chance your life could be different in a way you don't yet know. Don't you think we'd want your life to be one where people no longer get impatient with you?

He started giggling.  Not because he found it funny. It was his emotive response.

A-One: Stop talking about it.  I'm not doing it.

Mum: Well, you've assessed that you don't need this program.  What about the people who are offering the program?  Don't you think they'd be able to tell whether you're a suitable candidate?  If we put in an expression of interest, that doesn't mean you'd automatically be doing the program.  They might decide that it wouldn't really help you, and you'd be right after all.  Couldn't we at least see what they say?

I can't quite recall if he said anything after that. It seemed to me he was still intransigent, so I thought I'd draw round one to a close.  I knew it would take some time for him to get used to the idea, even if just to agree to an expression of interest.

That evening, his father said to me simply, 'He's doing it.'  He went to A-One's room to talk it over with him.

After about 20 minutes, his father reported that A-One had agreed to the expression of interest.

The chorus (A-One's youngest sister) commented: Gee, I was expecting there to be shouting and tears over this tonight, but it was all very calm and controlled. Wow.

I'm not sure where the magic happened.

A-One may be right.  This program may not be the right one for him.  It's for people with average or above average intelligence, and in the past A-One's tests put him at low average - yet still in the average range.

At least we have a chance to find out now.

Turbo in waiting?

A-One's fortnightly appointment with his employment consultant falls due tomorrow, and he is meant to have had at least 8 employer contacts since the last meeting.  That was his 'homework' for the last meeting, and the one before that too, but the dog ate it both times.

I reminded him yesterday that we'd better get down to the shopping centre today if he is not to be embarrassed about not having done his homework.

Mum: When do you want to get started tomorrow?

A-One: Early.

Mum: What time is 'early'?

A-One: I don't know. Just early in the morning.

Mum: Well, early in the morning could mean 5am.

A-One: Not that early.

Around 10am, after I had finished my exercise, I woke him.  I calculated that he might be ready by the time I'd finished my shower.

Mum: Time to wake up.  We going to the shopping centre today?

A-One: What for? ... Oh, yeh.

Mum: So get up.  Have breakfast.  Do you need to shower?  Also, empty the dishwasher before we go too.  Get cracking.  We're not going down there at 4pm because that will not be enough time.  And if you leave it until lunch time, the people you want to see may be on lunch.  Come on.  Time to get up and at 'em.

We have had a few exchanges in the intervening hours in response to my
'A-One, what's happening?'s:

A-One: I've only just finished my breakfast ... What should I wear? .... I'm just getting dressed .... I need to check something in my resume ....  I'm just getting something ....

It's now past 2pm.  It appears not a creature is stirring ... I'd better go see what's happening again.

Status Check

A-One hasn't done much brain training over the last month - just one day in the last four weeks.  His last score on Lumosity was 45th percentile, comprising the following sub-percentiles:

• Speed: 72.4
• Memory: 60.1
• Attention: 46.8
• Flexibility: 53.9
• Problem Solving: 9.1

All of the above are well within the average range, except Problem Solving.  I reckon his overall BPI would be higher than 45th percentile if he learnt his number facts.

So, has anything changed for A-One from his brain training?

When he met with his employment consultant yesterday discussing kitchen hand work, I noticed that he worked out how many years he'd been cleaning up the kitchen at home when I said he'd been rostered on that job since he was at least 8 years old.  Next week he turns 23.  He casually slipped into his conversation 'So, I've been doing that for 15 years.'  No pause, no counting on fingers.

I've also been noticing that his conversations as he plays WOW with his online friends are quite coherent and not all one-way.  Quite different from just a few years ago when he'd get on to a topic and keep talking regardless of signals that it was time to let someone else speak, or to inquire after them.  It all sounds very regular to me.

He now needs to build his confidence, and become motivated to get out of his comfort zone at home.

The best laid plans ...

At his meeting with his employment consultant yesterday, A-One reported on the job ads he had found interesting over the last fortnight, even if just a little.

A-One: There was one that required some packaging of orders, with some reception and admin work.  But they wanted someone who could 'work under pressure', and 'answer phone calls at reception'.

Consultant: Let me stop you right there.  How do you know if your idea of pressure is the same as their idea of pressure? You don't really know until you try.  When you think maybe you can't do it, I want you to put those thoughts away, and give it a go.  It's a good to be in the habit of applying, and good practice if you get an interview.  And when they say they want experience? Remember, you say you are willing to learn.

A-One: Yes.

Consultant: As you say, you might not find cleaning jobs really interesting, but you need to start somewhere, and from there you can work on to other jobs that you like better.

Mum: Yes, over the last fortnight, I heard A-One say for the first time ever 'working my way up'!

Consultant: Yes, that's how it can work. Will you get to your 8 employer contacts for our next meeting?

A-One: Yes, I'll do that.

On the way home, the plan had been to go via the shopping centre so that A-One could drop in his resume at his targeted shops (electronic gaming), as well as be on the look out for those looking for staff.

Mum: We'll just stop by home first so that you can swap the thongs for some shoes.

A-One: So, we're going home first now?  ... I really need a haircut too.

Mum: We could do that right now if you like.

A-One: OK.   Now, (consulting his iPod notes) how do I pay for this with my card again? Do I press credit or savings?

The haircut and payment duly executed, we headed for the 'quick' stop at home. He headed for the toilet.

Thirty minutes later:

Mum: A-One, how long will you be?  We'll run out of time!

A-One: We won't do it this afternoon.

After he emerged, he sat at his computer:

Mum: So when do you want to go down to the shopping centre?

A-One: I don't know.

Mum: If you need my help to get there, or to help you practice what to say before you talk to employers, you need to give me a time.  But if you go there on the bus, or walk, then it's up to you.

A-One: I don't know!  I need to think about it.

Mum: OK. How long do you think you'll need to think about it?

A-One: I don't know!

I moved on to something else.  Another day, another try ...

Job Hunting?

A-One and I had an appointment with his employment consultant again yesterday.  He had been given 'homework' - to have 8 employer contacts (submitted his resume) in the preceding fortnight.

Since the last appointment I had been reminding him about looking up the job sites in the way his consultant had shown him, or heading down to the local shopping centre to hand in his resume.  Despite his insistence to the contrary, as far as I could tell not much had been happening because he usually asks me questions when he's perusing jobs.

I woke him at 11:30am for a 1pm appointment.  At 12:30pm, he stepped dressed from the shower:

A-One: We should go down to the shopping centre before our meeting.

Mum: We don't have time for that now.  We have to leave here by 12:45pm at the latest to make it to the appointment by 1pm.

A-One: Yes, we'll have time.  I can't really go with nothing to show.

Mum: I'm glad to see you realise your obligations, but it needs more time than we have right now.  We simply won't make it by 1pm if we go down to the shopping centre now.

A-One: How do you know that? All I have to do is eat my breakfast and clean my teeth and then we can go to the shopping centre.

I left it as a rhetorical question until he had finished his food and cleaned his teeth.  By that time it was 1:45pm.

Mum: Are you ready to go now?

A-One: Yes.

Mum: You realise we're only just going to make it to the meeting?

A-One: Okay Mum.  You don't have to keep going on about it.

I went out to the car with A-One following me. He then rushed upstairs saying he'd forgotten something.  By the time we were backing out the driveway, it was 4 minutes to 1pm.

A-One: What will I say?

Mum: What do you think you might say?

A-One: I don't know.  That's why I'm asking you.

Mum: You'll have to call (consultant) to let him know we will be late.  (This happens for just about every meeting.)

A-One (on his mobile): Just calling to let you know we'll be a bit late.  We're on our way ... No, I didn't get around to that ... yes, we can talk about it soon.

A-One (off the phone): So, what should I say?

Mum: Well, what have you done in the last fortnight?

A-One: I've been looking, but I don't see jobs I'm interested in or think I could do.  (Pause)  ... I could tell him what I've done. And we could go down to the shopping centre on the way home after the meeting.  So I can tell him what I plan to do too.

Mum: Sounds good to me.  Still, it's better to be able to tell what you've done than what you plan to do.

Testing

A-One and I have finally completed his practice and baseline tests using CogStateTM.  For him to have had sufficient sleep it usually means he's free in the afternoons, but I'm not always free then.  In my attempts to co-ordinate our schedules I'd occasionally hear faint mumblings of ... 'not important' ... but, in the end, he submitted relatively graciously.

To administer the tests I was required to read the instructions while they were also presented to him on the screen.  For the practice tests, he usually read ahead and pressed on without waiting for me to finish the instructions.  Except the working memory tests - he read and re-read them before proceeding.

For the baseline tests, because they are timed and should be done without significant breaks, I asked him if he needed a glass of water or to use the toilet before we started.  He decided he did.

An hour later (sigh) we got started.

Again I read the preparatory instructions, reminding him that the tests were the same as the practice tests, just different in the specifics so that they are still 'fresh'.

Mum: Are you ready to start?

A-One: Not yet.  I'll let you know.

A minute or so passed.

Mum: Are you ready yet?

A-One: No.  I'll let you know when I am.

A minute or so passed.

Mum: How about now?

A-One: No. Not yet.

Mum: Are you composing yourself, getting your mind ready for this?

A-One: Yes.

The first baseline test was to remember a shopping list.  As I started to read out the items, he burst out, 'Aren't these meant to be the same words as before?'  So we used up some seconds as I explained that the test is the same, but the words are different.  That's what the 'composing' time had been about - trying to remember the words from the practice test!

For most of the tests again, he pressed on without waiting for me to finish reading the instructions, except for the more challenging of the working memory tests.  We completed all the tests in about an hour and fifteen minutes. My observation, supported by the test results, showed that his working memory is quite good. When tests required that he 'work out' a rule or find a path in a maze, he performed better than when he had to remember many things short term.  But for anything that had made it into his memory, his delayed recall was then good.  This is consistent with our experience of him - it might take a while for something to get into his brain, but once it's there, it's there forever!  So it sounds to me like he would benefit from practising learning things off by heart - not so much to know many more things, but to practice the learning technique required to remember things.

Mum: Do you want to see your test results?

A-One: Nah.

Pondering the good working memory results, and recalling that his previous neuro-psyche tests indicated a weak working memory, I asked him if he was willing to do a little exercise that would take only a minute (a working memory test).

Mum: I'll give you five numbers and I want you to repeat them back to me - backwards.

A-One: OK.

Mum: 7    3     9     5     8

A-One gazed down with a look of concentration on his face.  After about 15 seconds he looked at me and giggled.  He looked down again for about another 10 seconds.  Looked up, giggling again.

Then, tumbling the numbers out in quick succession:

A-One: 85937!

CogState

An article on SharpBrains referred to using a battery of online cognitive tests developed by CogStateTM, an Australian company based in Melbourne, listed in the top five in SharpBrains' Market Report.

When I had previously looked at CogStateTM's website I had noted that their target markets were primarily for testing cognitive capacities in the aging (Alzheimer's) and sports (concussions), clinical trials for pharmaceuticals, as well as use by academic researchers. I hadn't pursued it at the time because I hadn't thought that the work I was doing with A-One fitted any of those categories.

However, following on from my thinking in The Challenge blog, I wrote to CogStateTM several weeks back making an enquiry about the use of their tests. I was looking for an economical way to independently assess cognitive progress using Lumosity, or CogniFit, or any other online brain training.

Much to my excitement, CogStateTM has offered me the use of their Research battery of tests for 12 months!  This will enable me to take an independent baseline of A-One's cognitive capacities now, and to periodically check how he's going as he continues his training. I'm hoping that it will also help me better target the training that A-One requires.

I checked with A-One whether he was willing to undertake the tests.

A-One: How long will they take?

Mum: Each test takes between a few to several minutes, and there are about a dozen tests. Doing the tests would take perhaps an hour, but the total time would probably be longer than that as you would need to learn what each test entails.

A-One: OK.

So far, so good. No resistance.

I downloaded the software yesterday.  The software comes with a research manual which I have been reading and I'm now training myself in how to administer the tests.

I'm also putting on my thinking cap about how to gather others similar to A-One so that he has some fellow travellers wishing to improve their cognitive capacities. CogStateTM has told me that I am free to use the tests for such a group.

I hope I can keep A-One as excited about this as I am!

Under his own steam

Over the last month I have not been overseeing A-One's brain training too closely.  Under his own steam he has averaged training 3 times a week, which I'm very pleased about. 

At 53.6th percentile, his Flexibility has now finally passed the 50th percentile which is great news too! 

His Problem Solving is the only area that still lags under 10th percentile.

Over the last month we have been learning more about his WOW friends because he talks to them frequently, using his headphones and microphone. When playing, he sits in our family room so that he can use the internet cable instead of our unreliable wireless - we can't help overhearing his end of the conversations.  His sitting in our family area helps to include his online life with ours.

The Challenge

A few days ago I was reading a SharpBrains article about whether brain training really works, and read with interest my own burning question: 'how to max­i­mize the like­li­hood of trans­fer from train­ing to daily life.'

One of the conditions is that it must target a bottleneck. 'For instance, if you need to train your exec­u­tive func­tions but use a pro­gram designed to enhance speed of pro­cess­ing, you may well con­clude that this pro­gram does not “work.” But this pro­gram may work for some­body whose bot­tle­neck is speed of pro­cess­ing ...'

Bingo.
This is the area where I have been looking lately for some professional assistance.  Where is the user's guide to online brain training, so that someone can pick the right brain training exercise for their specific area of impairment?  Even the jargon for describing cognitive capacities seems to vary between sites, or is too general, so it's not always clear which exercises match A-One's specific deficits.


To this end, I have contacted some organisations to raise the possibility of combining professional expertise with online brain training, not for general brain fitness but specifically to improve cognitive deficits, just as I am trying to do with A-One.

For example, the co-ordinator of a 'brain gym' for brain injured soldiers at Walter Reed Military Hospital in the US presented at SharpBrain's Virtual Summit last year. She described how they use readily available brain exercises based on peer reviewed neuroscience, delivered via various media - online, mobile device apps, Nintendo etc - combined with standardised neuropsych evaluations to help soldiers rehabilitate their cognitive capacities after an injury, so that it is evidence based.

It seems to me that A-One could benefit from working with others seeking to improve capacity in their areas of cognitive deficit, where each person's brain exercises are targeted to their individual bottlenecks.  I think he would benefit from the social aspects of meeting with others, as well as increased motivation to keep working at it.

I keep coming back to the initial assessment phase of the Arrowsmith program and the classroom environment for delivery, and why that has been so successful. Could there be something similar for readily available, and inexpensive, online brain training?

So I'm running a few parallel paths of activity at the moment:

• I'm contacting support organisations for people with learning disabilities or developmental or neurological deficits, with a view to joining with other parents and practitioners who have an interest in brain training to see what we could get happening for group training, especially for adults with average or above average intelligence with cognitive deficits.
• I've contacted TAFE to discuss what would be needed for TAFE to deliver the Arrowsmith program
• I have been raising awareness of the educational implications of developments in neuroscience, and the Arrowsmith program in particular.  For example, Coursera have recently announced their Continuing Professional Development program for Teachers which includes a course called The Brain-Targeted Teaching® Model for 21st Century Schools from Dr. Mariale Hardiman at John Hopkins University. I've alerted the Learning Support teacher at my daughter's school to this, and she is raising it with the school's senior admin. I also sent a link to my contact at TAFE, and the Australian Arrowsmith program as it may be a useful supplementary professional development course for teachers involved in this year's pilot in Sydney.